Lymphogranuloma venereum: Difference between revisions

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==Background==
==Background==
* L1, L2, L3 serovars of [[Chlamydia trachomatis]]
*Cased by L1, L2, L3 serovars of [[Chlamydia trachomatis]]<ref name="Ceovic">Ceovic R, Gulin SJ. Lymphogranuloma venereum: diagnostic and treatment challenges. Infection and Drug Resistance. 2015;8:39-47. doi:10.2147/IDR.S57540.</ref>
* Sexually transmitted
*Sexually transmitted
* Often co-infected with [[HIV]]
*Often co-infected with [[HIV]]
*More common in tropical and sub-tropical climates


==Clinical Features==
==Clinical Features<ref name="Ceovic" />==
* 1st stage: Self-limited painless genital papules/ulcers
*Incubation period 3-30 days
* 2nd stage: Painful Inguinal +/or femoral LAN
*'''Stage 1 (Primary)''': Self-limited ''painless'' genital papule/ulcer (lasts ~2-3 days)
** Systemic: Fever, myalgia, malaise
**Seen on coronal sulcus in men, posterior vaginal fourchette in women
*** Arthritis, ocular dz, cardiac, pulmonary, aseptic meningitis, hepatitis
**Can also occur in rectum (hemorrhagic proctitis), urethra, vagina
* 3rd state: Proctocolitis
*'''Stage 2 (Secondary)''': ''Painful'' inguinal and/or femoral lymphadenopathy (2-6 weeks after primary lesion)
** Rectal pain, discharge, bleeding, fistula, abscess, strictures
**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
*'''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==
==Differential Diagnosis==
* [[HSV-2]]
{{STD DDX}}
* [[Syphilis]]
* [[Chancroid]]
* [[Colitis]]
* [[Granuloma inguinale]]


==Workup==
==Evaluation==
* NAAT or immunofluorescence
*Nucleic Acid Amplification Tests (NAAT)
* Culture (Needle aspiration at bubo)
*Immunofluorescence
* Seology
*Culture (needle aspiration of bubo)
* HIV testing
*Serology
* May warrant anoscopy
*Consider anoscopy
*Also consider testing for [[HIV]] and other possible coinfections


==Management==
==Management <ref> https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf </ref>==
* [[Doxycycline]] 100mg PO BID x 21 days (TOC) or
{{LGV antibiotics}}
* [[Erythromycin]] base 500mg PO qid x 21 days
* + [[Ceftriaxone]] 250mg IM x 1 if proctocolitis
** Preferred for pregnant and lactating females
* Treat sexual partner
** If asymptomatic: [[Doxycycline]] 100mg PO BID x 7 days or [[azithromycin]] 1gm PO 1 once


==Disposition==
==Disposition==
* Instruct patient to abstain from sexual activities
*Discharge
*Instruct patient to abstain from sexual activities until completion of treatment


==See Also==
==See Also==
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*[[Chlamydia trachomatis]]
*[[Chlamydia trachomatis]]


==Sources==
==External Links==
 
==References==
<references/>
<references/>
* Zenilman JM, et al. Lymphogranuloma venereum. In: Post T, ed. UpToDate. Waltham, Mass.: UpToDate; 2014. www.uptodate.com. Accessed December 24, 2014.
* Arsove P, et al. (2014, Jun 30). Lymphogranuloma Venereum. eMedicine. Retrieved 12/24/2014 from http://emedicine.medscape.com/article/220869-overview


[[Category:ID]]
[[Category:ID]]

Latest revision as of 06:59, 14 May 2022

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
  • 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

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

Disposition

  • Discharge
  • Instruct patient to abstain from sexual activities until completion of treatment

See Also

External Links

References

  1. 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.
  2. https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf