Lymphogranuloma venereum
(Redirected from Lymphogranuloma Venereum)
Background
- Cased by L1, L2, L3 serovars of Chlamydia trachomatis[1]
- Sexually transmitted
- Often co-infected with HIV
- More common in tropical and sub-tropical climates
Clinical Features[1]
- Incubation period 3-30 days
- Stage 1 (Primary): Self-limited painless genital papule/ulcer (lasts ~2-3 days)
- Seen on coronal sulcus in men, posterior vaginal fourchette in women
- Can also occur in rectum (hemorrhagic proctitis), urethra, vagina
- Stage 2 (Secondary): Painful inguinal and/or femoral lymphadenopathy (2-6 weeks after primary lesion)
- Lymph nodes become necrotic → suppurative → formation of buboes
- Fluctuant lymph nodes classically form a "groove sign" when adenopathy extends above and below the inguinal ligament
- Systemic symptoms: fever, myalgia, malaise
- Occasionally - arthritis, ocular, cardiac, pulmonary, aseptic meningitis, hepatitis
- Lymph nodes become necrotic → suppurative → formation of buboes
- Stage 3 (Tertiary): Proctocolitis, anorectal syndrome
- Usually manifests in women or men who have sex with men
- Rectal pain, discharge, bleeding
- Can also → fistula, abscess, strictures, megacolon
Differential Diagnosis
Sexually transmitted diseases
- Chancroid
- Chlamydia trachomatis
- Granuloma inguinale
- Hepatitis B
- Herpes Simplex Virus-2
- HIV
- Human papillomavirus
- Lymphogranuloma venereum
- Neisseria gonorrhoeae
- Trichomonas
- Syphilis
Evaluation
- Nucleic Acid Amplification Tests (NAAT)
- Immunofluorescence
- Culture (needle aspiration of bubo)
- Serology
- Consider anoscopy
- Also consider testing for HIV and other possible coinfections
Management [2]
- Doxycycline 100mg PO BID x 21 days (first choice) OR
- Erythromycin 500mg PO QID x 21 days OR
- Preferred for pregnant and lactating females
- Azithromycin 1g PO weekly for 3 weeks OR
- Alternative for pregnant women - poor evidence for this treatment currently
- Tetracycline, Minocycline, or Moxifloxacin (x21 days) are also acceptable alternatives to Doxycycline
- Treat sexual partner
- Doxycycline 100mg PO BID x 7 days OR
- Azithromycin 1gm PO x1
Disposition
- Discharge
- Instruct patient to abstain from sexual activities until completion of treatment
See Also
External Links
References
- ↑ 1.0 1.1 Ceovic R, Gulin SJ. Lymphogranuloma venereum: diagnostic and treatment challenges. Infection and Drug Resistance. 2015;8:39-47. doi:10.2147/IDR.S57540.
- ↑ https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf