Lymphogranuloma venereum: Difference between revisions

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==Clinical Features<ref name="Ceovic" />==
==Clinical Features<ref name="Ceovic" />==
*Incubation period 3-30 days
*Incubation period 3-30 days
*Stage 1 (Primary): Self-limited painless genital papule/ulcer (lasts ~1 week)
*'''Stage 1 (Primary)''': Self-limited painless genital papule/ulcer (lasts ~1 week)
**Seen on coronal sulcus in men, posterior vaginal fourchette in women
**Seen on coronal sulcus in men, posterior vaginal fourchette in women
**Can also occur in rectum (hemorrhagic proctitis), urethra, vagina
**Can also occur in rectum (hemorrhagic proctitis), urethra, vagina
*Stage 2 (Secondary): Painful inguinal and/or femoral lymphadenopathy (2-6 weeks after primary lesion)
*'''Stage 2 (Secondary)''': Painful inguinal and/or femoral lymphadenopathy (2-6 weeks after primary lesion)
**Lymph nodes become necrotic → suppurative → formation of buboes
**Lymph nodes become necrotic → suppurative → formation of buboes
**Systemic symptoms: fever, myalgia, malaise
**Systemic symptoms: fever, myalgia, malaise
***Occasionally - arthritis, ocular, cardiac, pulmonary, aseptic meningitis, hepatitis
***Occasionally - arthritis, ocular, cardiac, pulmonary, aseptic meningitis, hepatitis
*Stage 3 (Tertiary): Proctocolitis, anorectal syndrome
*'''Stage 3 (Tertiary)''': Proctocolitis, anorectal syndrome
**Usually manifests in women or homosexual men
**Usually manifests in women or homosexual men
**Rectal pain, discharge, bleeding
**Rectal pain, discharge, bleeding
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==Diagnostic Evaluation==
==Diagnostic Evaluation==
* Nucleic Acid Amplification Tests (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==

Revision as of 01:29, 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)
  • Immunofluorescence
  • Culture (needle aspiration of bubo)
  • Serology
  • Consider anoscopy
  • Also consider testing for HIV and other possible coinfections

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.