Lymphogranuloma venereum: Difference between revisions

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== Background ==
==Background==
* Infection caused by [[Chlamydia trachomatis]] serovars L1, L2 and L3
* Transmitted sexually through vaginal, anal, or oral contact


*Infection caused by [[Chlamydia trachomatis]] serovars L1, L2 and L3
=== Epidemiology ===
*Transmitted sexually through vaginal, anal, or oral contact
* Uncommon in Canada but more common in parts of Africa, Asia, South America, and the Caribbean
* Occasional outbreaks among men who have sex with men


===Epidemiology===
== Clinical Manifestations ==
=== Primary LGV ===
* Incubation period 3 to 30 days
* Starts with small painless papule at site of inoculation that may ulcerate
* Only noticed in 50% of patients


*Uncommon in Canada but more common in parts of Africa, Asia, South America, and the Caribbean
=== Secondary LGV ===
*Occasional outbreaks among men who have sex with men
* Latency of 2 to 6 weeks from primary lesion
* Presents with systemic symptoms, including fevers and chills, malaise, myalgias, and arthralgias
* May have abscess with or without draining sinuses
* Occasionally involves arthritis, pneumonitis, hepatitis, and rarely involves carditis, aseptic meningitis, or ocular inflammation


==Clinical Manifestations==
==== Secondary LGV with lymphadenopathy ====
===Primary LGV===
* Most commonly involves painful inguinal or femoral lymphadenopathy, called "buboes"
* The "groove sign", where nodes are seen above and below the inguinal ligament, is highly specific for LGV


*Incubation period [[Usual incubation period::3 to 30 days]]
==== Secondary LGV with anorectal symptoms ====
*Starts with small painless papule at site of inoculation that may ulcerate
* Presents with acute hemorrhagic proctitis
*Only noticed in 50% of patients
* May also cause constipation


=== Tertiary LGV ===
===Secondary LGV===
* Also called chronic LGV, and occurs in 10 to 20% of untreated patients
* Characterized by chronic inflammation that causes:
** Lymphadtic obstruction leading to genital elephantiasis
** Genital and rectal strictures and fistulae
* Can cause esthiomene, extensive destruction of genitalia


*Latency of 2 to 6 weeks from primary lesion
== Investigations ==
*Presents with systemic symptoms, including fevers and chills, malaise, myalgias, and arthralgias
* Anoscopy/sigmoidoscopy/proctoscopy
*May have abscess with or without draining sinuses
** Similar appearance to ulcerative colitis
*Occasionally involves arthritis, pneumonitis, hepatitis, and rarely involves carditis, aseptic meningitis, or ocular inflammation
* Bubo aspiration
** Usually contains small amount of milky fluid
** Aspirate through healthy skin


====Secondary LGV With Lymphadenopathy====
== Prevention ==

* Consistent use of condoms or other barrier methods, including for oral sex
*Most commonly involves painful inguinal or femoral lymphadenopathy, called "buboes"
* Avoid mucosal trauma if possible
*The "groove sign", where nodes are seen above and below the inguinal ligament, is highly specific for LGV

====Secondary LGV With Anorectal Symptoms====

*Presents with acute hemorrhagic proctitis
*May also cause constipation

===Tertiary LGV===

*Also called chronic LGV, and occurs in 10 to 20% of untreated patients
*Characterized by chronic inflammation that causes:
**Lymphadtic obstruction leading to genital elephantiasis
**Genital and rectal strictures and fistulae
*Can cause esthiomene, extensive destruction of genitalia

==Investigations==

*Anoscopy/sigmoidoscopy/proctoscopy
**Similar appearance to ulcerative colitis
*Bubo aspiration
**Usually contains small amount of milky fluid
**Aspirate through healthy skin

==Diagnosis==

*Typically done by diagnosing [[Chlamydia trachomatis]] and then confirming the serotype with the reference laboratory
*Sample should be taken from swab of lesion (if primary), or bubo aspirate, swab of rectum, vagina, oropharynx, or urethra, or urine (if secondary or tertiary)
*Chlamydia testing with culture or NAAT
*Confirmatory testing with DNA sequencing or RFLP at a reference laboratory

==Management==

*Do not treat with excision or incision and drainage
*Antibiotics
**First-line: [[Is treated by::doxycycline]] 100 mg PO bid for 21 days
**Alternative: [[Is treated by::erythromycin]] 500 mg PO qid for 21 days
**Alternative: [[Is treated by::azithromycin]] 1 g PO weekly for 3 weeks
*Perform a test-of-cure at 3 to 4 weeks following completion of treatment
*Also treat any sexual partners within the last 60 days
**[[Azithromycin]] 1 g PO once or [[doxycycline]] 100 mg PO bid for 7 days
*Also rule out other concurrent sexually-transmitted infections, including [[chancroid]] and [[donovanosis]]

==Prevention==

*Consistent use of condoms or other barrier methods, including for oral sex
*Avoid mucosal trauma if possible


[[Category:Sexually-transmitted infections]]
[[Category:Sexually-transmitted infections]]

Latest revision as of 16:35, 3 December 2020

Background

  • Infection caused by Chlamydia trachomatis serovars L1, L2 and L3
  • Transmitted sexually through vaginal, anal, or oral contact

Epidemiology

  • Uncommon in Canada but more common in parts of Africa, Asia, South America, and the Caribbean
  • Occasional outbreaks among men who have sex with men

Clinical Manifestations

Primary LGV

  • Incubation period 3 to 30 days
  • Starts with small painless papule at site of inoculation that may ulcerate
  • Only noticed in 50% of patients

Secondary LGV

  • Latency of 2 to 6 weeks from primary lesion
  • Presents with systemic symptoms, including fevers and chills, malaise, myalgias, and arthralgias
  • May have abscess with or without draining sinuses
  • Occasionally involves arthritis, pneumonitis, hepatitis, and rarely involves carditis, aseptic meningitis, or ocular inflammation

Secondary LGV With Lymphadenopathy

  • Most commonly involves painful inguinal or femoral lymphadenopathy, called "buboes"
  • The "groove sign", where nodes are seen above and below the inguinal ligament, is highly specific for LGV

Secondary LGV With Anorectal Symptoms

  • Presents with acute hemorrhagic proctitis
  • May also cause constipation

Tertiary LGV

  • Also called chronic LGV, and occurs in 10 to 20% of untreated patients
  • Characterized by chronic inflammation that causes:
    • Lymphadtic obstruction leading to genital elephantiasis
    • Genital and rectal strictures and fistulae
  • Can cause esthiomene, extensive destruction of genitalia

Investigations

  • Anoscopy/sigmoidoscopy/proctoscopy
    • Similar appearance to ulcerative colitis
  • Bubo aspiration
    • Usually contains small amount of milky fluid
    • Aspirate through healthy skin

Diagnosis

  • Typically done by diagnosing Chlamydia trachomatis and then confirming the serotype with the reference laboratory
  • Sample should be taken from swab of lesion (if primary), or bubo aspirate, swab of rectum, vagina, oropharynx, or urethra, or urine (if secondary or tertiary)
  • Chlamydia testing with culture or NAAT
  • Confirmatory testing with DNA sequencing or RFLP at a reference laboratory

Management

  • Do not treat with excision or incision and drainage
  • Antibiotics
  • Perform a test-of-cure at 3 to 4 weeks following completion of treatment
  • Also treat any sexual partners within the last 60 days
  • Also rule out other concurrent sexually-transmitted infections, including chancroid and donovanosis

Prevention

  • Consistent use of condoms or other barrier methods, including for oral sex
  • Avoid mucosal trauma if possible