Enlarged Inguinal Nodes (BUBO)

Clinical Description

• Both chancroid and lymphogranuloma venereum (LGV) can cause bubo.
• Exclude the following conditions which may also cause enlarged inguinal lymph nodes: septic skin lesions on thigh, foot, leg, toes, buttock, anus, perineum, scrotum, penis, labia, vulva and vagina, systemic infections. e.g., Hepatitis B, HIV, infectious mononucleosis, syphilis, TB, bubonic plague, cat scratch fever, trypanosomiasis, lymphoma, leukemia, Kaposi's sarcoma.
• Exclude other conditions which may cause groin swelling unrelated to enlarged lymph nodes including inguinal hernia, lipoma, a boil in overlying skin.
• Confirm presence of bubo by careful examination

Note: All patients with bubo should be carefully examined for signs of other STIs

Treatment

• If bubo present and genital ulcer present, treat as for genital ulcer disease
• If bubo present, and painful, fluctuant or recent onset (under 2 weeks) and no genital ulcer present: treat patient and partner for LGV
• Give Doxycycline 100mg 12 hourly with food for 14 days. If pregnant/ lactating, give

Erythromycin 500mg 6 hourly for 14 days

• If bubo fluctuant, aspirate through adjacent normal skin (do not incise)
• If enlarged inguinal lymph node present, but not painful, fluctuant or of recent onset (under 2 weeks) and no genital ulcer present: look for other causes of inguinal swelling:
• e.g., generalized lymphadenopathy (rule out secondary syphilis and HIV), hernia, tumour.
• Refer for biopsy if indicated
• If bubo not present but other signs of STI found, treat accordingly
• If bubo not present and other signs of STI not found, reassure, educate/counsel the patient
• Promote/provide condoms