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]]


==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 ~1 week)
** 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
**Systemic symptoms: fever, myalgia, malaise
***Occasionally - arthritis, ocular, cardiac, pulmonary, aseptic meningitis, hepatitis
*Stage 3 (Tertiary): Proctocolitis, anorectal syndrome
**Usually manifests in women or homosexual men
**Rectal pain, discharge, bleeding
**Can also → fistula, abscess, strictures, megacolon


==Differential Diagnosis==
==Differential Diagnosis==
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* [[Granuloma inguinale]]
* [[Granuloma inguinale]]


==Workup==
==Diagnostic Evaluation==
* NAAT or immunofluorescence
* Nucleic Acid Amplification Tests (NAAT) or immunofluorescence
* Culture (Needle aspiration at bubo)
* Culture (Needle aspiration at bubo)
* Seology
* Seology
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==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==
==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]]

Revision as of 01:21, 7 September 2015

Background

Clinical Features[1]

  • Incubation period 3-30 days
  • Stage 1 (Primary): Self-limited painless genital papule/ulcer (lasts ~1 week)
    • 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
    • Systemic symptoms: fever, myalgia, malaise
      • Occasionally - arthritis, ocular, cardiac, pulmonary, aseptic meningitis, hepatitis
  • Stage 3 (Tertiary): Proctocolitis, anorectal syndrome
    • Usually manifests in women or homosexual men
    • Rectal pain, discharge, bleeding
    • Can also → fistula, abscess, strictures, megacolon

Differential Diagnosis

Diagnostic Evaluation

  • Nucleic Acid Amplification Tests (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

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

See Also

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.