This standard specifies the diagnostic criteria and treatment principles for lymphogranuloma venereum. This standard is applicable to medical care institutions, health and epidemic prevention institutions, and STD prevention and control institutions at all levels across the country. WS 237-2003 Diagnostic criteria and treatment principles for lymphogranuloma venereum WS237-2003 standard download decompression password: www.bzxz.net

Chapter 2 of this standard is mandatory, and the rest are recommended. ws237-2003
Veinlymphatic granulomatous serotypes of Chlamydia trachomatis (L1, 2, L3). Since the 20th century, sporadic clinical suspected cases have been reported in my country, and the number of reported cases has increased. In order to provide reliable diagnosis and reasonable treatment for patients with venereal granulomatous ... In the process of formulating this comprehensive standard, we carefully studied the diagnostic criteria and treatment plans for STDs and the STD diagnosis and treatment guidelines and STD treatment recommendations issued by the Ministry of Health, reviewed the diagnostic criteria for lymphogranuloma venereum issued by the Centers for Disease Control and Prevention in the United States in 1997, the 1998 World Health Organization guidelines for the treatment of sexually transmitted diseases issued by the Centers for Disease Control and Prevention of the United States, and the relevant provisions of the STD guidelines issued by the British Society for Reproductive Medicine and Disease Research in 1999. Appendix A of this standard is a summary of the historical data of the STDs. This standard was prepared by the Department of Disease Control of the Ministry of Health. The drafting unit of this standard is the Chinese Institute of Medical Sciences: the main drafters of this standard are Su Xiaohong and Wang Shiqiu. This standard is interpreted by the Office of Communicable Disease Prevention and Control and Management of the Ministry of Health. 1
Diagnostic criteria for lymphogranuloma venereum
Treatment principles
This standard specifies the diagnostic criteria and treatment principles for lymphogranuloma venereum. This standard is applicable to all medical and health institutions and STD prevention agencies nationwide. 2 Diagnostic criteria
2.1 History of infection
There is a history of non-sexual contact with sexually transmitted infections.
2.2 Clinical manifestations
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2.2.1 This disease is a sexually transmitted disease caused by the microscopic hemolytic subtypes of Chlamydia trachomatis, 1.1, 1.2, and 1.4. The incubation period is 2-21 days, with an average of 7 weeks. It can be clinically divided into three stages: early, middle, and late. 2.2.2 Early manifestations: Primary lesions are painless papules, papular rashes or dense blisters, with shallow lesions or ulcers. They mainly occur in the external genitals, such as the sulcus, glans, foreskin, and penis of men, and the two posterior walls, labia, frenulum, or other parts of the neck of women. If the urine is affected, non-specific urinary symptoms may occur. Indirectly affected patients may develop autointestinal inflammation, which is common in male homosexual or female patients. Primary lesions often occur in other parts, and need not be treated. 2.2.3 Mid-term manifestations: 1 to 1 week after the onset of the original skin lesions, patients will develop lymphadenitis, lymphadenitis and pain, which are the clinical manifestations of venereal lymphoma. They are the main reasons for most patients to seek medical treatment. Two-thirds of the cases are single cases, which may be single or multiple lymph nodes. Painful lymphadenitis is the most common. Swollen lymph nodes may necrotize, rupture or rupture, forming cysts or discharge. Multiple cases may form a "water kettle" shape. When the lumbar and femoral lymph nodes and femoral lymph nodes are affected at the same time, the femoral lymph nodes separate these two groups of swollen nodes, forming the so-called "groove sign". The "groove sign" is a common manifestation of venereal lymphoma, but it is only seen in 15% to 20%. Patients. Other parts of the glandular nodes may also be affected: female patients with collateral lymphadenopathy account for 2%-30%, deep cavitary lymph nodes may be affected, and the lower and lumbar lymph nodes may be affected. Since the lymphatic tissue is involved, there will be rectal and rectal peri-abdominal charcoal, which is called acute rectal syndrome. Patients with acute rectal syndrome have symptoms such as fever, tenesmus, thick rectal secretions or blood in the eyes, constipation or constipation. Patients with acute lymphadenopathy may have systemic symptoms such as fever, headache, and pain, as well as skin nodular erythema or erythema multiforme-like rash.
2.2.4 Late clinical manifestations are rectal peri-abdominal swelling, hemiplegia, intestinal vaginal congestion, hepatic congestion and rectal swelling, and acute rectal elephantiasis. 2.3 Laboratory examination
2.3.1 Serological test
2 weeks after infection, Blood donations from donors are collected for immunohistochemical tests. A high titer of chlamydia trachomatis (1:1:2) or a titer of 4 times the titer of the previous and subsequent chlamydia trachomatis is of diagnostic significance for venereal lesions. 2.3.2 Tissue pathological examination
Swollen lymph nodes are collected for pathological examination. The presence of stellate lymph nodes and bud formation is a diagnostic consideration. Summary: 2.3.3 Chlamydia trachomatis antigen detection or cell culture is performed by collecting samples from the genitals or rectum, or extracting concentrated samples from swollen lymph nodes and inoculating them with MC cells for Chlamydia trachomatis culture and typing (Appendix A). Isolation of Chlamydia trachomatis with a rate of L1.2-13 can confirm the elimination of Chlamydia trachomatis. Lymph node specimens tested by immunofluorescence test (Figure A) are also of diagnostic significance if they contain luminescent Chlamydia trachomatis inclusion bodies. 2.4 Case classification
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2.4.1 Clinical diagnosis cases
According to 2.1 and 2.2. and excluding other causes of hemiplegia or lymphadenopathy. The primary cases should meet the following requirements according to the stage:
a) Negative for syphilis treponema pallidum by microscopic examination of tissue fluid, or negative for serological test; b) Clinical exclusion of herpes simplex virus (HSV) infection: or negative for ISV culture. 2.4.2 Confirmed cases
Selection of cases that meet 2.:, 2.?, and any of the indicators in 2.3. 3 Treatment principles
Clear and timely treatment; adequate and regular medication: different treatment plans should be used for different diseases. During treatment, non-sexual and sexual companions should be avoided: examination and treatment should be carried out, and follow-up and elimination should be carried out after treatment. 4 Clinical cure
After treatment, the patient's active symptoms and signs disappear and can be judged as clinically cured. Usually 3 to 6 days are needed, and no antibiotic test is generally required. Antibiotic treatment is effective for multiple sexual infections of venereal lymphoma, such as early lymph node lesions and proctitis. Late-stage serious lymphoma caused by pregnancy is often irreversible. 5 Management and prevention
Venereal lymphoma and other diseases are usually transmitted through sexual intercourse. It is common in people with sexual intercourse. Female asymptomatic carriers are the main source of infection, making the control and prevention of venereal lymphoma more difficult. Confirmed cases or patients who have sexual contact within 3 days before the onset of the disease should be given timely treatment to eliminate the source of infection and reduce the spread of the disease. That is to say, follow-up should be conducted after the treatment. Both parties should investigate the possible sexually transmitted diseases of the treatment group, and the natural persons and key groups should be advised to adjust their education and promote sexual behavior changes, avoid non-marital sexual relations, and provide safety protection for couples. wwW.bzxz.Net
A1 Collection of specimens
Appendix A
(Normative Appendix
Experimental diagnosis of lymphogranuloma venereum WS237—2003
Chlamydia trachomatis is a lipid-containing fungus. If pathogenic examination is required, the specimen must not contain cellular components. Specimens are usually collected from diseased tissues or gradual nodes. For lymph nodes with fluctuations, after routine skin cleaning and disinfection, the needle is inserted from the adjacent wall to perform lymph node puncture and aspirate the fluid. Draw a line around the fluctuation of the large vernier node and inject 1m of water into the middle of the node. Remove the oily liquid from it. For lesions: first use a sterile cotton swab to wipe the surface of the lymph node The dirt on the skin should be removed, and the swab should be used to take a sample from the base or edge of the infected area. The specimens used for culture should be placed in a transport medium and sent to the laboratory within 18 days, or stored in a refrigerator for use. A.2 Microimmunofluorescence test (MIF)
MIF is an indirect immunofluorescence test. This method uses various types of Chlamydia trachomatis selected and extracted from the yolk sac of chickens and fixed with malin as antigens. The type-specific Chlamydia trachomatis antibodies in the blood of the subjects are measured. A.2.1 Method
A.2.1.1 Use a pointed pen to dot each type of antigen on the glass slide in a certain order, dry in air for 3 minutes, and fix with acetone for 10 minutes. A.2.1.2 Add the serum diluted by 1.8 times (more than 1.8) to each group of antigen spots, place the smear at 37 °C and wash with PBS and distilled water, then add the antibody-labeled anti-human immunoglobulin (1 μg or 1 μM) to the antigen spots, incubate, wash and remove the medium, 4.2.1.4 Add glycerol to the antigen spots, cover with slides, and observe under a microscope. Check if there is any fluorescence on each antigen spot:
4, 2. 2 Results
The reaction point is demarcated as the antigen spot with the highest amount of fluorescence, and the antigen type that shows a positive reaction with the serum with the highest screening concentration is the infected Chlamydia trachomatis type, A, 2.3 Clinical significance
Chlamydia trachea anti-antibody titer is low in uncomplicated ureteral collection, while the antibody titer is very high in deep infection or systemic infection. The antibody titer of 1:5-2 (IgG or 1:2Ig) in the microimmunofluorescence test is of diagnostic significance for venereal lymphoma. An increase in the antibody titer between the two tests is of diagnostic significance. A.2.4 Items
Before the test, the antigen needs to be titrated so that the antigen released by the test can obtain strong isotropic properties. A.3 Direct immunofluorescence test (DTF)
A.3.1 Principle
The antigen working medium is prepared with PB5 and filtered through a filter (0.45u> standard high-speed centrifugation (15)g + 4% 5umin) for evaluation. Fluorescence-labeled monoclonal antibody against Chlamydia outer membrane protein: Smear the specimens for staining. If the specimens contain inclusion bodies or plasminogen activators, the antigen-antibody will be selectively stained, and the chlamydial particles can be seen under the fluorescence microscope. 4.3.2 Materials
Produce mouse monoclonal antibody against Chlamydia outer membrane protein labeled with fluorescent markers, add 0.1% azide-containing deionized water, sterilize and seal. 3
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4.3.3 Methods
A.3.3.1 Place the labeled cells in 0.5mL of water, half on the upper part of the slide and the other half on the lower part, and air dry. 4.3.3.2 Each well of the standard slide should be coated with 30% of the reagent. 4.3.3.3 Place the slide in a wet medium for 15 minutes. Rinse with 1% evaporation water or deionized water to remove excess reagent, air dry, and then add 1 drop of the standard slide to each well. Observe under fluorescent light (400°C). 4.3.4 Results: In the positive specimens, there should be chromatin-colored, pin-sized particles, which should be red in color. For the partial chromatin specimens, 1 plasminogen activator particle per slide should be recorded as positive. Sometimes, 2 to 3 times larger plasminogen activators can be found, which can be used to identify the required chlamydia, reticular or reticular. 4.3.5 Clinical significance
LSIF has a high risk of diagnosing Chlamydia trachomatis. The detection of Chlamydia trachomatis particles in the microscopic parts of the infected organs, the aspirate of the infected fluid or the cells of the infected tissue supports the diagnosis of venereal lymphoma. A, 3.6 Precautions
This test kit mainly examines the whole urine and intestines. In addition, the specimens of the colon and larynx should be taken in symptomatic patients. This test cannot be used as a cure test.
This test requires technical requirements, the result judgment is subjective, and the observer needs to have certain experience. To ensure the correctness of the judgment result, the observer should be trained.
When observing the results, you should recognize the following points: pay attention to distinguishing between non-specific inflammatory light, spontaneous charcoal light and other false positives. Some pigments, bacteria, epithelial cells or cell fragments, and bacteria will emit non-specific light, but their color and size are different from the body. The shell color may be yellow, but not beige.
A.4 Chlamydia trachomatis cell culture
4.4:1 Pretreatment of specimens
Put the specimens (extracted, aspirated, reduced) in 37 °C water at 79 °C, and swab them under aseptic conditions. The true content of the specimens should be determined by using antibiotics (including antibiotics, The aspirate was diluted with growth medium 1:10 to test its anti-chlamydial effect.
4.4.2.1 Cell growth medium
Each 10ml contains RPMI 11645.=1% bovine serum 154g/ml streptomycin 2/ml streptomycin 3[/ml., IIEFFS10r 1. mal/1., L-glutamine 2mmol/L, sodium bicarbonate, 2h to 7.*, 4.4.2.2 Sample delivery to the customer
per 1000ml. For growth culture, add 3.5g of bacteria. 4.4.2.3 Isolation culture medium
Cell growth selection medium plus cycloheximide (release two negative). The final temperature is 1. 4.4.2.4 Calcium-free 1BS
per effective sodium chloride phosphate 0.15
potassium dihydrogen phosphate (KH2PO4):
A, 4.2.5 Trypsin-RDTA solution
per 200mL calcium-free 1BS. 3.1% sodium hydroxide, 30g A. 4.2.6 Iodine staining solution
40ml. Hot enough water. Liu Shizhong l5.ug, 5.g of iodine, 5ml of A.4
A, 4.2.7 Iodine glycerol sealing solution
and other salts and boron staining solutions mixed with oil:
4.4.3 Methods
A, 4.3.1 Preparation of MeCoy cell monolayer
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Collect MeCoy cells from liquid nitrogen and thaw them in 37℃ water. Add them to a culture bottle with lipid-adjusted growth medium and incubate for 2 hours. After oxygen is removed, replace with fresh growth medium. Continue to culture at 33℃ for 3 hours until the cells are fused into a monolayer. After overnight incubation, wash the monolayer with a small amount of urea-protein solution. Add EDTA to digest the monolayer and incubate at room temperature for 2min-3min to allow the cells to separate completely. , and then let it suspend for a period of time. Count the cells with a hemacytometer, and then dilute with the culture medium until it reaches the required concentration (if it is necessary to form a monolayer of cells in the well plate after 48 hours, the concentration of Mycobacterium is preferably 1:1, and then inoculate it into the wells of a 96-well microtiter plate, and add 1.2L of cell culture medium to each well. A circular glass with a diameter of 0.cm has been pre-heated at the bottom of the well of the microtiter plate, and the cells will grow on this slide immediately. Incubate in 5% oxygen () and 36% humidified air for 4 hours. Observe under a microscope that the cells have grown into a monolayer. The following steps are as follows: 1.4.3.2 Inoculation of specimens
Take out the 96-well short-well short-cell monolayer that has grown for 4 hours, aspirate the culture medium in the well, and add 0.1ml of the specimen solution that has been buried. Inoculate 2 wells of the whole specimen (one well to observe the results, and the other well to pass the test). Each batch of clinical specimens shall be equipped with attached control and immediate control. The inoculated specimen plate shall be kept at 36℃ for 1~2h (centrifugation is not required). The inoculated specimen liquid shall be aspirated and the separation medium containing effective isolation shall be added to each batch of specimens. The separation medium shall be added to each batch of specimens and the culture medium shall be added to the culture medium for 4h under the conditions of 55% micron dioxide (1% ) and 46℃ and humid air. Then the results shall be observed. A4.3.3 Observation of the results
The commonly used methods for culture slides are iodine staining, iodine staining and fluorescence staining. The staining methods are as follows: | a) Remove the micronuclei from the separation medium; add 0.2 ml of separation medium and place it in the culture wells. Discard the alcohol and add a.2 ml of true color solution for 5 min and then discard the staining solution; add 1 ml of glycerol sealing solution on the washed slides: take the slides out of the wells, lower the cell surface and place them on the sealing surface for observation under a microscope (1x magnification). Chlamydia are contained in the new microscopic structure and stained dark brown. If there is, it means that trachoma bacteria are present. If not, scrape the cells on the other slide and make inclusions, then continue the previous method to inoculate new spores. After culture, observe the complex. If there are still no inclusion bodies, it is confirmed as medical. If there are inclusion bodies, it is confirmed as non-medical. When the inclusion bodies are not typical or the product cannot be determined by true staining, 95% ethanol can be used for decolorization for 2min-3min, and then re-identify with a single point marked by fluorescence. The method of spore staining is basically the same as that of the raw material staining, except that after fixing with methanol, 0.2 μm is added and stained. Remove the slides from the rack, rinse with lysine, take the slides, dry naturally, and then follow the steps of immunofluorescence as follows: a) Use a pipette to remove the cultured H. It is fixed with 100 μl of acetylcholine (T). After 10 min, add 0.2 μl of fluorescein-containing goat cloned antibody and incubate for 30 min at T. a) Remove the cultured H. It is fixed with acetylcholine (T). b) Add 0.1 μl of fluorescein-containing goat cloned antibody and incubate for 30 min at T. a) Remove the cultured H. It is fixed with acetylcholine (T). c) Remove the cultured H. It is fixed with acetylcholine (T). d ...4 Results
Classical staining and Giemsa staining were examined under an optical microscope: When Giemsa staining was performed in dark vision, the chlamydia bodies were yellowish with fluorescence, which was easier to identify than the conventional color staining. After staining, the chlamydia bodies were stained brown due to the presence of glycogen, and the green fluorescent bodies were visible in the bright light staining. 4,4, 3. 5 Clinical significance
Cell culture is the "standard" method for diagnosing Chlamydia trachomatis. It has a high specificity (1CU%). Since the cultured cells have a positive effect, the diagnostic accuracy of venereal lymphoma is usually only about 50%. Culturing Chlamydia trachomatis from skin aspiration or lymph node aspiration can clearly identify the presence of venereal lymphoma. A.4.3.6 Precautions
A4.3.6, 1Moy red run rate should be appropriate, the cell monolayer produced should not be too sparse, which will affect the growth of the chlamydia. The appropriate cell inoculation concentration should be selected in advance. 2.4.3.6.2 When cells are aged, infected or damaged by endogenous factors, false positives may occur. At this time, fresh, uncontaminated cells need to be replaced. , sometimes it is necessary to use its detection method. A, 4.3.6.3 The source and batch number, preparation position of each reagent in each culture medium should be ensured to prevent the source of the problem. After the culture medium is prepared, it should first be tested for its effect on the growth of cells with known pathogens to see if there is any infection, and then it should be used for clinical testing.
4, 4.3.6.4 The key components in the culture medium should meet the quality requirements, and each serum should be tested for its suitability for the growth of Chlamydia.
A4.3.6.5 The concentration of active mycelial activity also has a great influence on the growth of Chlamydia. The method should be verified in advance, and different viscosities of chloramphenicol should be added to the culture medium to achieve the most appropriate working concentration. 6
B, 1 Treatment Objective
Appendix B
(Standard Appendix)
Treatment of Lymphoma Venereum
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Timely and effective antibiotic treatment can cure residual infection, relieve clinical symptoms, prevent further damage, shorten the course of the disease, and eliminate infectiousness. However, in the late stage, patients with severe damage should follow the instructions for follow-up treatment. B.2 Recommended follow-up treatment regimens:
) Doxetine 100 mg/day 3 times a month
) 1 mg/day 1 time a day for 21 days or
c) Tetracycline 50 mg/day 4 times a year for 14 days or
) Minoxone 100 mg/day 2 times a year. The above standard regimens should be used in combination with the patient, especially for women who are breastfeeding. Women should use levofloxacin. For coagulable infection, more than one course of treatment can be used, and the above-mentioned fluid can be used alternately: For patients with HV infection, treatment can be appropriately extended: puncture is performed instead of suction of visceral fluid, and surgical drainage is not recommended. For ulcers or ulcers, surgical repair or plasty can be performed, for ulcers, dilatation can be performed, and for ulcers, remodeling can be performed. Before surgery is performed on patients with related infections, regular anti-cancer treatment should be given. B.3 Follow-up and judgment of cure
Patients should be followed up after treatment, and clinical symptoms and signs should disappear, usually 3 weeks. Microbiological tests are generally not required.
B.4 Sexual partners
Sexual contact with them should be examined and treated within 3 days before the onset of clinical symptoms. WS237-—2003
References
17 Health and Disease Control Department of the People's Republic of China. STD Diagnosis and Treatment Plan (Provisional)[5.22, Department of Epidemic Prevention of the Ministry of Health of the People's Republic of China. STD Treatment Book (Volume 2) Nanjing: Jiangsu Science and Technology Press, 194.18841
L5_ Department of Disease Control of the Ministry of Health of the People's Republic of China. STD Diagnosis and Treatment Standards and STD Treatment Recommendations, 2000.810[4] Zeng Renshan also STD Lymphoma Volume 1, Mei Zhihua, ed., Modern Venereology, 149154[5_ National STD Monitoring Coordination Group .1999 comprehensive analysis of venereal disease, Chinese Journal of STD Prevention and Control, 2000, 120-132 [6 Liu Wen. Case report, Chen Ming venereal lymphoma, a case report of Chinese Journal of Dermatology and Venereology. 1995; 9: 155-156 [main, straight-sigmoid tuberculosis, a case report of venereal lymphoma, Journal of Clinical Effects, 1955: 14: 4418 single Hong, Modern Pathology (2nd Edition) Commercial Press, 1931, 41\42619] Department of Dermatology, Xi'an Medical College, Clinical Medicine, People's Health Press, 1962. 6388 [lo] Centers ior hscare Cautrul Bnd P-ventirm, Cane definitions for intectizusunder pahlieheatb surveil'arce.MMwR J9S7: 4h32[6 Liu Wentao. Case report, Chen Ming venereal lymphoblastoma: a case report. Journal of Dermatology and Venereology. 1995;9:155-156[Main, Zhisuo-sigmoid tuberculosis: a case report. Clinical effect of semi-synthetic lymphoma. Journal of Modern Diseases (2nd edition). Commercial Press, 1993,41\42619] Department of Dermatology, Xi'an Medical College, Clinical Medicine, People's Health Press, 1962.6388[lo] Centers ior hscare Cautrul Bnd P-ventirm, Cane definitions for intectizusunder pahlieheatb surveil'arce.MMwR J9S7:4h32[6 Liu Wentao. Case report, Chen Ming venereal lymphoblastoma: a case report. Journal of Dermatology and Venereology. 1995;9:155-156[Main, Zhisuo-sigmoid tuberculosis: a case report. Clinical effect of semi-synthetic lymphoma. Journal of Modern Diseases (2nd edition). Commercial Press, 1993,41\42619] Department of Dermatology, Xi'an Medical College, Clinical Medicine, People's Health Press, 1962.6388[lo] Centers ior hscare Cautrul Bnd P-ventirm, Cane definitions for intectizusunder pahlieheatb surveil'arce.MMwR J9S7:4h,55FIll Cunlk-s far Tixrne Control and Irevention. iudl ihe Eurnpean (tize pf the World Health Orgarization Eurupunguil-iur or ihe mauagenucnt ot 1ropical genitn ulcerative discesce. Int J Si AITxs, 20c1 12 Supp3: 73-3.1.
131 Pele: t. Perinc arc Waltcr E Suwmrn , lyphogranuioma Vencreum. ln: Holnes KK, et tl.eds. sexually tronsiltud linrnes, 3rd et. New Yark, McGriw Hill, 15s5,123 432I=I1j K-llark,R Tarlmw, SK Suvarla.er, al. lymnphngranuloma Venereurn, liajxy,erology,uml rnri. atar hielogy. Gertiiour:n Med 15u:/d,3uf-4rl15J TJ Kroven, A Yca-Muore, unid SK Tyring. An nvervicw of sexual traasmicted diseases,(Part1).JAmAzud 1nrr-nl 19a9,21:5t[-529.13i H Van Dyak, 7. A Meheus and P Piot. Laboratory Diegnosis uf urw aully Irnnkmittad disea-ses.(iznevaWurdHeatik Craanuzationluga,22-35.
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