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 (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

• Instruct patient to abstain from sexual activities

See Also

• STDs
• Chlamydia trachomatis

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