Lymphogranuloma venereum: Difference between revisions
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*Sexually transmitted | *Sexually transmitted | ||
*Often co-infected with [[HIV]] | *Often co-infected with [[HIV]] | ||
*More common in tropical and sub-tropical climates | |||
==Clinical Features<ref name="Ceovic" />== | ==Clinical Features<ref name="Ceovic" />== | ||
[[File:Lymphogranulomavenereum.jpg|thumb|Painless genital ulcer from lymphogranuloma venereum]] | |||
[[File:Lymphogranuloma venerum - lymph nodes.jpg|thumb|Inguinal femoral lymphadenopathy (bilateral) from lymphogranuloma venereum]] | |||
*Incubation period 3-30 days | *Incubation period 3-30 days | ||
*'''Stage 1 (Primary)''': Self-limited ''painless'' genital papule/ulcer (lasts ~ | *'''Stage 1 (Primary)''': Self-limited ''painless'' genital papule/ulcer (lasts ~2-3 days) | ||
**Seen on coronal sulcus in men, posterior vaginal fourchette in women | **Seen on coronal sulcus in men, posterior vaginal fourchette in women | ||
**Can also occur in rectum (hemorrhagic proctitis), urethra, vagina | **Can also occur in rectum (hemorrhagic proctitis), urethra, vagina | ||
*'''Stage 2 (Secondary)''': ''Painful'' inguinal and/or femoral lymphadenopathy (2-6 weeks after primary lesion) | *'''Stage 2 (Secondary)''': ''Painful'' inguinal and/or femoral lymphadenopathy (2-6 weeks after primary lesion) | ||
**Lymph nodes become necrotic → suppurative → formation of buboes | **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 | **Systemic symptoms: fever, myalgia, malaise | ||
***Occasionally - arthritis, ocular, cardiac, pulmonary, aseptic meningitis, hepatitis | ***Occasionally - arthritis, ocular, cardiac, pulmonary, aseptic meningitis, hepatitis | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{STD DDX}} | |||
==Evaluation== | ==Evaluation== | ||
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*Also consider testing for [[HIV]] and other possible coinfections | *Also consider testing for [[HIV]] and other possible coinfections | ||
==Management== | ==Management <ref> https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf </ref>== | ||
{{LGV antibiotics}} | {{LGV antibiotics}} | ||
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*[[STDs]] | *[[STDs]] | ||
*[[Chlamydia trachomatis]] | *[[Chlamydia trachomatis]] | ||
==External Links== | |||
==References== | ==References== | ||
Latest revision as of 18:38, 12 July 2023
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