Lymphogranuloma venereum: Difference between revisions
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**Aspirate through healthy skin |
**Aspirate through healthy skin |
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+ | ==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 |
| − | * |
+ | *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 |
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| − | * |
+ | *Also treat any sexual partners within the last 60 days |
| − | * |
+ | *Also rule out other concurrent sexually-transmitted infections, including [[chancroid]] and [[donovanosis]] |
==Prevention== |
==Prevention== |
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Revision as of 14:12, 30 July 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
- First-line: doxycycline 100 mg PO bid for 21 days
- Alternative: erythromycin 500 mg PO qid for 21 days
- Alternative: 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
- 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
