Lymphogranuloma venereum

Revision as of 03:45, 28 December 2014 by Rossdonaldson1 (talk | contribs) (Rossdonaldson1 moved page Lymphogranuloma Venereum to Lymphogranuloma venereum)

Background

  • L1, L2, L3 serovars of Chlamydia trachomatis
  • Sexually transmitted
  • Often co-infected with HIV

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

  • HSV-2
  • Syphilis
  • Chancroid
  • Colitis
  • Granuloma inguinale

Workup

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

Management

  • Doxycycline 100mg PO BID x 21 days (TOC) or
  • 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

  • Instruct patient to abstain from sexual activities

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