Lymphogranuloma venereum: Difference between revisions

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===Primary LGV===
 
===Primary LGV===
   
*Incubation period 3 to 30 days
+
*Incubation period [[Usual incubation period::3 to 30 days]]
 
*Starts with small painless papule at site of inoculation that may ulcerate
 
*Starts with small painless papule at site of inoculation that may ulcerate
 
*Only noticed in 50% of patients
 
*Only noticed in 50% of patients
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*Occasionally involves arthritis, pneumonitis, hepatitis, and rarely involves carditis, aseptic meningitis, or ocular inflammation
 
*Occasionally involves arthritis, pneumonitis, hepatitis, and rarely involves carditis, aseptic meningitis, or ocular inflammation
   
====Secondary LGV with lymphadenopathy====
+
====Secondary LGV With Lymphadenopathy====
   
 
*Most commonly involves painful inguinal or femoral lymphadenopathy, called "buboes"
 
*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
 
*The "groove sign", where nodes are seen above and below the inguinal ligament, is highly specific for LGV
   
====Secondary LGV with anorectal symptoms====
+
====Secondary LGV With Anorectal Symptoms====
   
 
*Presents with acute hemorrhagic proctitis
 
*Presents with acute hemorrhagic proctitis
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**Aspirate through healthy skin
 
**Aspirate through healthy skin
   
== Diagnosis ==
+
==Diagnosis==
   
* Typically done by diagnosing [[Chlamydia trachomatis]] and then confirming the serotype with the reference laboratory
+
*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)
+
*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
+
*Chlamydia testing with culture or NAAT
* Confirmatory testing with DNA sequencing or RFLP at a reference laboratory
+
*Confirmatory testing with DNA sequencing or RFLP at a reference laboratory
   
== Management ==
+
==Management==
   
* Do not treat with excision or incision and drainage
+
*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
+
**First-line: [[Is treated by::doxycycline]] 100 mg PO bid for 21 days
* Alternative: [[Is treated by::azithromycin]] 1 g PO weekly for 3 weeks
+
**Alternative: [[Is treated by::erythromycin]] 500 mg PO qid for 21 days
  +
**Alternative: [[Is treated by::azithromycin]] 1 g PO weekly for 3 weeks
* Also treat any sexual partners within the last 60 days
 
  +
*Perform a test-of-cure at 3 to 4 weeks following completion of treatment
* Also rule out other concurrent sexually-transmitted infections, including [[chancroid]] and [[donovanosis]]
 
 
*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==
 
==Prevention==

Latest revision as of 12:35, 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