Lymphogranuloma venereum: Difference between revisions

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==Management==
==Management==
* [[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==

Revision as of 16:48, 19 April 2015

Background

Clinical Features

  • 1st stage: Self-limited painless genital papules/ulcers
  • 2nd stage: Painful Inguinal +/or femoral LAN
    • Systemic: Fever, myalgia, malaise
      • Arthritis, ocular dz, cardiac, pulmonary, aseptic meningitis, hepatitis
  • 3rd state: Proctocolitis
    • Rectal pain, discharge, bleeding, fistula, abscess, strictures

Differential Diagnosis

Workup

  • NAAT or immunofluorescence
  • Culture (Needle aspiration at bubo)
  • Seology
  • HIV testing
  • May warrant anoscopy

Management

  • 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

  • Instruct patient to abstain from sexual activities

See Also

Sources

  • 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