//fpnotebook.com/
Lymphogranuloma venereum
Aka: Lymphogranuloma venereum, LGV, Lymphogranuloma venereum proctocolitis
- See Also
- Sexually Transmitted Infection
- Genital Ulcer
- Etiology
- Sexually Transmitted Infection
- Caused by Chlamydia trachomatis subtypes L1, L2, L3 in the United States
- Epidemiology
- Previously rare in the United States
- Recent outbreaks in U.S.
- More common in HIV patients and homosexual men
- Symptoms
- General
- Fever and chills
- Headache or meningismus
- Anorexia
- Arthralgias and Myalgias
- Proctocolitis if rectal exposure
- Mucus or bloody discharge from anus
- Anal Pain
- Constipation
- Tenesmus
- Signs
- Transient Genital Lesion (Genital Ulcer)
- Appears 3 days to 3 weeks after exposure
- Starts as nontender Papule
- Develops small painless Vesicle or non-indurated Genital Ulcer at site within 3 to 30 days
- Rectal lesion or Proctocolitis
- Women and homosexual men
- Rectal ulcer
- Bloody rectal discharge
- Inguinal Syndrome (Painful inguinal adenopathy)
- Occurs 2-6 weeks after exposure
- Unilateral in 66% of cases
- Painful, tender inguinal or femoral Lymphadenopathy (Bubo)
- Inguinal Lymphadenopathy: Groove sign
- Large circular lymph nodes (buboes) above and below inguinal ligament
- May also involve rectal lymph nodes
- May progress to matted nodes and fistulas
- Complications
- Perirectal Abscess
- Perianal Fistula or Stricture
- Secondary Bacterial Infection
- Lymphatic obstruction with secondary genital elephantiasis
- Diagnosis: Options (choose one)
- Chlamydia trachomatis serotype L1, L2, L3 culture positive
- Bubo aspirate
- Rectal lesion culture
- Immunofluorescence showing Leukocytes with inclusion bodies
- Inguinal lymph node aspirate
- Microimmunofluorescence positive
- Lymphogranuloma venereum strain of Chlamydia trachomatis
- Labs
- STD testing
- Chamydia PCR
- Gonorrhea PCR
- HIV Test (all patients with LGV)
- Syphilis Testing such as RPR (in all patients with LGV)
- Other labs are not required, but may be abnormal if tested for other reason
- Complete Blood Count
- Leukocytosis
- Erythrocyte Sedimentation Rate elevated
- Liver Function Tests abnormalities
- Diagnosis
- Diagnosis is clinical
- Chamydia Trachomatis PCR
- Positive in Lymphogranuloma venereum
- Aspiration of bubo can be sent to lab (but not needed if presentation is classic)
- Safe to aspirate, but do NOT lance buboes
- Do NOT biopsy lesions due to risk of sinus tract formations
- Differential Diagnosis
- See Genital Ulcer
- See Inguinal Lymphadenopathy
- Proctocolitis
- Inflammatory Bowel Disease
- Management
- Precautions
- Avoid incising or lancing buboes (needle aspiration is safe and some experts recommend)
- Treat for 3 weeks due to Lymphogranuloma venereum invasive and more difficult to treat nature
- Preganancy or Lactation
- Erythromycin base 500 mg orally four times daily for 21 days
- Active infection
- Doxycycline 100 mg orally twice daily for 21 days (preferred)
- Erythromycin base 500 mg orally four times daily for 21 days
- Azithromycin 1 gram once weekly for 3 weeks
- Treat asymptomatic sexual contacts from last 60 days
- Doxycycline 100 mg PO bid for 7 days OR
- Azithromycin 1 gram PO x1 dose
- Complications
- Proctocolitis
- Fistulas and strictures may occur with delayed treatment
- References
- (2004) MMWR Morb Mortal Wkly Rep 53(42): 985-8 [PubMed]
- Workowski (2006) MMWR Recomm Rep 55:1-94 [PubMed]