Lymphogranuloma venereum

Aka: Lymphogranuloma venereum, LGV, Lymphogranuloma venereum proctocolitis

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II. Etiology

  1. Sexually Transmitted Infection
  2. Caused by Chlamydia trachomatis subtypes L1, L2, L3 in the United States

III. Epidemiology

  1. Previously rare in the United States
  2. Recent outbreaks in U.S.
    1. More common in HIV patients and homosexual men

IV. Symptoms

  1. General
    1. Fever and chills
    2. Headache or meningismus
    3. Anorexia
    4. Arthralgias and Myalgias
  2. Proctocolitis if rectal exposure
    1. Mucus or bloody discharge from anus
    2. Anal Pain
    3. Constipation
    4. Tenesmus

V. Signs

  1. Transient Genital Lesion (Genital Ulcer)
    1. Appears 3 days to 3 weeks after exposure
    2. Starts as nontender Papule
    3. Develops small painless Vesicle or non-indurated Genital Ulcer at site within 3 to 30 days
  2. Rectal lesion or Proctocolitis
    1. Women and homosexual men
    2. Rectal ulcer
    3. Bloody rectal discharge
  3. Inguinal Syndrome (Painful inguinal adenopathy)
    1. Occurs 2-6 weeks after exposure
    2. Unilateral in 66% of cases
    3. Painful, tender inguinal or femoral Lymphadenopathy (Bubo)
      1. Inguinal Lymphadenopathy: Groove sign
        1. Large circular Lymph Nodes (buboes) above and below inguinal ligament
      2. May also involve rectal Lymph Nodes
    4. May progress to matted nodes and fistulas

VI. Complications

  1. Perirectal Abscess
  2. Perianal Fistula or Stricture
  3. Secondary Bacterial Infection
  4. Lymphatic obstruction with secondary genital elephantiasis

VII. Diagnosis: Options (choose one)

  1. Chlamydia trachomatis serotype L1, L2, L3 culture positive
    1. Bubo aspirate
    2. Rectal lesion culture
  2. Immunofluorescence showing Leukocytes with inclusion bodies
    1. Inguinal Lymph Node aspirate
  3. Microimmunofluorescence positive
    1. Lymphogranuloma venereum strain of Chlamydia trachomatis

VIII. Labs

  1. STD testing
    1. Chamydia PCR
    2. Gonorrhea PCR
    3. HIV Test (all patients with LGV)
    4. Syphilis Testing such as RPR (in all patients with LGV)
  2. Other labs are not required, but may be abnormal if tested for other reason
    1. Complete Blood Count
      1. Leukocytosis
    2. Erythrocyte Sedimentation Rate elevated
    3. Liver Function Tests abnormalities

IX. Diagnosis

  1. Diagnosis is clinical
  2. Chamydia Trachomatis PCR
    1. Positive in Lymphogranuloma venereum
  3. Aspiration of bubo can be sent to lab (but not needed if presentation is classic)
    1. Safe to aspirate, but do NOT lance buboes
    2. Do NOT biopsy lesions due to risk of sinus tract formations

X. Differential Diagnosis

  1. See Genital Ulcer
  2. See Inguinal Lymphadenopathy
  3. Proctocolitis
    1. Inflammatory Bowel Disease

XI. Management

  1. Precautions
    1. Avoid incising or lancing buboes (needle aspiration is safe and some experts recommend)
    2. Treat for 3 weeks due to Lymphogranuloma venereum invasive and more difficult to treat nature
  2. Preganancy or Lactation
    1. Erythromycin base 500 mg orally four times daily for 21 days
  3. Active infection
    1. Doxycycline 100 mg orally twice daily for 21 days (preferred)
    2. Erythromycin base 500 mg orally four times daily for 21 days
    3. Azithromycin 1 gram once weekly for 3 weeks
  4. Treat asymptomatic sexual contacts from last 60 days
    1. Doxycycline 100 mg PO bid for 7 days OR
    2. Azithromycin 1 gram PO x1 dose

XII. Complications

  1. Proctocolitis
    1. Fistulas and strictures may occur with delayed treatment

XIII. References

  1. (2004) MMWR Morb Mortal Wkly Rep 53(42): 985-8 [PubMed]
  2. Workowski (2006) MMWR Recomm Rep 55:1-94 [PubMed]

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Related Studies

Ontology: Lymphogranuloma Venereum (C0024286)

Definition (MSHCZE) Pohlavně přenášená nemoc vyvolaná chlamydiemi. Projevuje se drobným vřídkem na zevním pohlavním ústrojí a následným hnisavým zánětem tříselných mízních uzlin, který se může šířit až do pánevních uzlin a vést ke značně rozsáhlému poškození. Léčí se antibiotiky. Na rozdíl od venerického l. syfilitické postižení tříselných uzlin nehnisá a samo se ztrácí (později ovšem dochází k projevům dalších stadií). (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (MSH) Subacute inflammation of the inguinal lymph glands caused by certain immunotypes of CHLAMYDIA TRACHOMATIS. It is a sexually transmitted disease in the U.S. but is more widespread in developing countries. It is distinguished from granuloma venereum (see GRANULOMA INGUINALE), which is caused by Calymmatobacterium granulomatis.
Definition (CSP) subacute inflammation of the inguinal lymph glands caused by certain immunotypes of Chlamydia trachomatis; a sexually transmitted disease in the United States but is more widespread in developing countries; do not confuse with granuloma venereum, which is caused by Calymmatobacterium granulomatis, for this use ENTEROBACTERIACEAE DISEASE.
Concepts Disease or Syndrome (T047)
MSH D008219
ICD9 099.1
ICD10 A55
SnomedCT 89427004, 266213004, 154391003, 186946009
English Lymphogranuloma Inguinale, Lymphogranuloma Venereum, Chlamydial lymphogranuloma (venereum), LGV, Chlamydia trachomatis lymphadenitis, Durand-Nicolas-Favre disease, Lymphogranuloma Venereum [Disease/Finding], lymphogranuloma inguinale, lymphogranuloma venereum, lgv, Climatic or tropical bubo, chlamydial lymphogranuloma venereum, chlamydial infections lymphogranuloma venereum, chlamydial lymphogranuloma venereum (diagnosis), Lymphogranuloma venereum, Lymphogranuloma inguinale, LGV - Lymphogranuloma venereum, Nicholas Favre disease, Lymphogranuloma venereum (disorder), Favre-Nicolas, Frei, bubo; climactic, bubo; tropical, inguinal; lymphogranuloma, lymphogranuloma; chlamydial, lymphogranuloma; inguinale, lymphogranuloma; venereum, lymphopathia venereum, nicolas(-Durand)-Favre disease, poradenitis; nostras, Chlamydia; lymphadenitis, Chlamydia; lymphogranuloma, tropical; bubo, venereum; lymphogranuloma, Durand-Nicolas-Favre, Nicolas-Favre disease, Climatic AND/OR tropical bubo, Lymphogranuloma venereum (disorder) [Ambiguous], climatic; bubo
Dutch Chlamydia trachomatis lymfadenitis, lymphogranuloma inguinale, Chlamydia; lymfadenitis, Chlamydia; lymfogranuloom, bubo; climaticus, bubo; tropicus, inguinale; lymfogranuloom, lymfogranuloom; Chlamydia, lymfogranuloom; inguinale, lymfogranuloom; venereum, poradenitis; nostras, tropicus; bubo, venereum; lymfogranuloom, Lymphogranuloma (venereum) door Chlamydia, lymphogranuloma venereum, climaticus; bubo, Lymphogranuloma inguinale, Lymphogranuloma venereum
French LGV, Lymphadénite à Chlamydia trachomatis, Lymphogranulome inguinal, Maladie de Nicolas et Favre, Lymphogranulomatose inguinale subaigüe, LGV (LymphoGranulomatose Vénérienne), Lymphogranulomatose inguinale subaiguë, Lymphogranulomatose vénérienne, Lymphogranuloma venereum, Maladie de Nicolas-Favre
German Chlamydia trachomatis-Lymphadenitis, LGV, Lymphogranuloma inguinale (venereum) durch Chlamydien, Lymphgranulom venerisch, Lymphogranuloma inguinale, Lymphogranuloma venereum
Italian Linfoadenite da Chlamydia trachomatis, Linfogranuloma inguinale, Linfogranuloma venereo
Portuguese Linfadenite a Chlamydia trachomatis, Linfogranuloma inguinal, Linfogranuloma venéreo, Linfogranuloma Inguinal, Linfogranuloma Venéreo
Spanish Linfogranuloma inguinal, LGV, Linfadenitis por Chlamydia trachomatis, enfermedad de Nicolas - Favre, enfermedad de Durand - Nicolas - Favre, bubón climático Y/O tropical, bubón climático o tropical, LGV - Linfogranuloma venéreo, enfermedad de Nicholas Favre, linfogranuloma inguinal, linfogranuloma venéreo (concepto no activo), linfogranuloma venéreo (trastorno), linfogranuloma venéreo, Linfogranuloma venéreo, Linfogranuloma Inguinal, Linfogranuloma Venéreo
Japanese 性病性リンパ肉芽腫症, 鼡径リンパ肉芽腫, ｿｹｲﾘﾝﾊﾟﾆｸｹﾞｼｭ, ｾｲﾋﾞｮｳｾｲﾘﾝﾊﾟﾆｸｹﾞｼｭｼｮｳ, トラコーマクラミジア性リンパ節炎, ﾄﾗｺｰﾏｸﾗﾐｼﾞｱｾｲﾘﾝﾊﾟｾﾂｴﾝ, ニコラ･ファブル病, リンパ肉芽腫-性病性, 性病性リンパ肉芽腫, 第4性病, 第四性病, 鼠径リンパ肉芽腫, 鼠径リンパ肉芽腫症, リンパ肉芽腫-鼠径
Swedish Lymphogranuloma venereum
Czech lymphogranuloma venereum, Lymphogranuloma venereum, Lymfadenitida vyvolaná Chlamydia trachomatis, Lymphogranuloma inguinale, venerický lymfogranulom, lymfogranuloma venereum, LGV, Nicolas-Favreova nemoc, lymfogranulom inguinální, morbus Nicolas - Favre, morbus venereus quartus
Finnish Lymphogranuloma venereum
Russian LIMFOGRANULEMA VENERICHESKAIA, ЛИМФОГРАНУЛЕМА ВЕНЕРИЧЕСКАЯ
Korean 클라미디아 림프육아종(성병성)
Croatian ČETVRTA SPOLNA BOLEST, LYMPHOGRANULOMA VENEREUM
Polish Choroba Nicolasa-Faure'a, Ziarnica weneryczna, Ziarnica pachwinowa, Ziarnica weneryczna pachwin, Choroba Duranda, Ziarniniak weneryczny
Hungarian lymphogranuloma inguinale, lymphogranuloma venereum, Chlamydia trachomatis lymphadenitis, LGV
Norwegian Chlamydialymfogranulom, Klamydialymfogranulom, Venerisk lymfogranulom, Lymfogranulom, venerisk, Lymphogranuloma venereum, Lymphogranuloma inguinale
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Sexually Transmitted Disease

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