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) | * Nucleic Acid Amplification Tests (NAAT) | ||
* Culture ( | * Immunofluorescence | ||
* | * Culture (needle aspiration of bubo) | ||
* | * Serology | ||
* | * Consider anoscopy | ||
* Also consider testing for HIV and other possible coinfections | |||
==Management== | ==Management== | ||
Revision as of 01:29, 7 September 2015
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 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
- 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