Lymphogranuloma venereum

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