Lymphogranuloma venereum: Difference between revisions
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==Background== | ==Background== | ||
* 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> | *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<ref name="Ceovic" />== | ==Clinical Features<ref name="Ceovic" />== | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
* [[HSV-2]] | *[[HSV-2]] | ||
* [[Syphilis]] | *[[Syphilis]] | ||
* [[Chancroid]] | *[[Chancroid]] | ||
* [[Colitis]] | *[[Colitis]] | ||
* [[Granuloma inguinale]] | *[[Granuloma inguinale]] | ||
==Diagnostic Evaluation== | ==Diagnostic Evaluation== | ||
* Nucleic Acid Amplification Tests (NAAT) | *Nucleic Acid Amplification Tests (NAAT) | ||
* Immunofluorescence | *Immunofluorescence | ||
* Culture (needle aspiration of bubo) | *Culture (needle aspiration of bubo) | ||
* Serology | *Serology | ||
* Consider anoscopy | *Consider anoscopy | ||
* Also consider testing for HIV and other possible coinfections | *Also consider testing for HIV and other possible coinfections | ||
==Management== | ==Management== | ||
Revision as of 07:18, 6 July 2016
Background
- Cased by L1, L2, L3 serovars of Chlamydia trachomatis[1]
- Sexually transmitted
- Often co-infected with HIV
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 men who have sex with 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
- Doxycycline 100mg PO BID x 7 days OR
- Azithromycin 1gm PO x1
Disposition
- Discharge
- Instruct patient to abstain from sexual activities until completion of treatment