173: Lymphogranuloma Venereum Flashcards
(112 cards)
1
Q
What are the primary epidemiological characteristics of Lymphogranuloma Venereum (LGV)?
A
- Endemic in regions such as India, Southeast Asia, West Africa, South and Central America, and some Caribbean Islands.
- Accounts for 7% to 19% of genital ulcer diseases in Africa and India.
- Most affected are sexually active individuals aged 15 to 40, particularly in urban areas and lower socioeconomic status.
- Men are 6 times more likely than women to manifest clinical infection.
- Low incidence in developed countries, often limited to travelers or military personnel returning from endemic areas.
2
Q
What are the main routes of transmission for Lymphogranuloma Venereum (LGV)?
A
- Direct contact with infectious secretions through unprotected intercourse (oral, vaginal, or anal).
- Asymptomatic rectal infection and/or penile and oral infection are likely sources of onward transmission.
- Other routes include sexual practices such as fisting and sex-toy sharing, which are significant risk factors for transmission.
3
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What are the clinical findings associated with the primary stage of Lymphogranuloma Venereum (LGV)?
A
- Occurs 3 to 30 days after infection.
- Characterized by 5 to 8 mm painless erythematous papules or small herpetiform ulcers at the site of inoculation.
- Painful ulcerations and nonspecific urethritis are less common.
- Lesions in males typically occur on the coronal sulcus, prepuce, or glans penis, while in females, they are found on the posterior wall of the vagina, vulva, or cervix.
4
Q
What is the etiology of Lymphogranuloma Venereum (LGV)?
A
- Caused by Chlamydia trachomatis serovars L1, L2, and L3.
- Recent outbreaks are primarily due to serovar L2, particularly L2b.
- The L2c variant suggests a more aggressive clinical course, leading to severe proctitis.
- Chlamydia trachomatis has two distinct morphologic forms: the elementary body (infectious) and the reticulate body (metabolically active but non-infectious).
5
Q
A patient presents with a painless erythematous papule on the glans penis that healed spontaneously. What stage of LGV does this represent, and what is the typical timeline?
A
This represents the primary stage of LGV, which occurs 3-30 days after infection.
6
Q
A patient with LGV has a history of fisting and sex-toy sharing. How do these practices contribute to the transmission of LGV?
A
These practices facilitate direct contact with infectious secretions, increasing the risk of LGV transmission.
7
Q
A patient with LGV has a history of crack cocaine use. What is the epidemiological significance of this finding?
A
An epidemic of LGV has been reported among crack cocaine users in the Bahamas, highlighting a potential risk factor.
8
Q
A patient with LGV has a history of asymptomatic rectal infection. What is the significance of asymptomatic carriers in LGV transmission?
A
Asymptomatic carriers, especially women, can serve as reservoirs of infection, facilitating onward transmission.
9
Q
A patient with LGV has been diagnosed with a serovar L2c infection. What is the clinical significance of this serovar?
A
The L2c serovar is associated with a more aggressive clinical course, often causing severe proctitis.
10
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The L2c variant has been reported in new cases in Spain, Finland, the Czech Republic, and the Netherlands, suggesting its spread.
11
Q
A patient with LGV has been diagnosed with a genital ulcer. What are the key features that differentiate LGV ulcers from herpetic lesions?
A
LGV ulcers are painless and transient, whereas herpetic lesions are typically painful.
12
Q
A patient with LGV has a genital ulcer. What is the typical size and appearance of the primary lesion?
A
The primary lesion is a 5- to 8-mm painless erythematous papule or small herpetiform ulcer.
13
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A
The primary lesion appears 3-30 days after infection.
14
Q
What are typical locations of primary stage LGV in males?
A
In males, the primary lesion is usually located on the coronal sulcus, prepuce, or glans penis.
15
Q
What are the typical locations of primary stage LGV in females?
A
In females, the primary lesion is usually located on the posterior wall of the vagina, vulva, or occasionally the cervix.
16
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In rectal inoculation, the primary lesion may occur in the rectum.
17
Q
Aside from genital and rectal, what are other typical locations of inoculation of the primary lesion of LGV?
A
Lip or pharynx.
18
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In lip inoculation, the primary lesion may occur on the lip.
19
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In cervical inoculation, the primary lesion may occur on the cervix.
20
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In vaginal inoculation, the primary lesion may occur on the posterior wall of the vagina.
21
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- Endemic in India, Southeast Asia, East and West Africa, South and Central America, and some Caribbean Islands.
- Accounts for 7% to 19% of genital ulcer diseases in these areas.
- Most affected are sexually active persons aged 15 to 40 years, particularly in urban areas and lower socioeconomic status.
- Men are 6 times more likely than women to manifest clinical infection.
- Low incidence in developed countries, often limited to travelers or military personnel returning from endemic areas.
22
Q
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A
- Direct contact with infectious secretions through unprotected intercourse (oral, vaginal, or anal).
- Asymptomatic rectal infection and/or penile and oral infection are likely sources of onward transmission.
- Other routes include sexual practices such as fisting and sex-toy sharing, with fisting identified as a major predisposing factor.
23
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- Occurs 3 to 30 days after infection.
- Characterized by 5 to 8 mm painless erythematous papules or small herpetiform ulcers at the site of inoculation.
- Painful ulcerations and nonspecific urethritis are less common.
- Initial lesions may be differentiated from herpetic lesions by the lack of associated pain.
- Lesions in males usually occur on the coronal sulcus, prepuce, or glans penis; in females, on the posterior wall of the vagina, vulva, or cervix.
24
Q
What factors contribute to the misdiagnosis of Lymphogranuloma Venereum (LGV) in men who practice insertive anal sex?
A
- High proportion of men practicing insertive anal sex are misdiagnosed or undiagnosed due to:
- Organism-related factors
- Host-related factors (e.g., sexual practices such as fisting and use of sex toys, IV drug use, HIV status)
- Physician-related factors (failure to diagnose genital LGV).
25
How does the clinical course of Lymphogranuloma Venereum (LGV) differ between serovars L2b and L2c?
- Serovar L2b is associated with recent outbreaks and is a common cause of LGV.
- Serovar L2c suggests a more aggressive clinical course, leading to severe proctitis and potentially more severe symptoms compared to L2b.
26
What are the implications of asymptomatic carrier states in women for the transmission of Lymphogranuloma Venereum (LGV)?
- Women may harbor asymptomatic persistent infections in the cervical epithelium, serving as reservoirs for the infection.
- This asymptomatic carrier state can facilitate the onward transmission of LGV to sexual partners, complicating control efforts.
27
What are the distinct morphologic forms of Chlamydia trachomatis and their characteristics?
- Elementary Body: Small, metabolically inactive, and infectious
- Reticulate Body: Larger, metabolically active, and non-infectious
28
What are the common diagnostic challenges associated with Lymphogranuloma Venereum (LGV)?
- Common diagnostic laboratory methods are nonspecific and not readily available in endemic areas.
- Only a few laboratories offer specific assays to LGV serovars, leading to misdiagnosis as common chlamydial urogenital infections.
29
What are the potential complications associated with untreated Lymphogranuloma Venereum (LGV)?
- Untreated LGV can lead to severe complications such as:
- Chronic proctitis
- Lymphadenopathy
- Potential for systemic spread of infection
- Long-term sequelae affecting reproductive health.
30
What is the significance of the serovar classification of Chlamydia trachomatis in relation to Lymphogranuloma Venereum (LGV)?
- Serovar classification helps in understanding the pathogenicity and clinical manifestations of infections.
- Different serovars are associated with specific diseases, with LGV serovars being more invasive and having a high affinity for macrophages, leading to lymphadenitis.
31
What are the common clinical findings in the secondary stage of Lymphogranuloma Venereum (LGV)?
- Marked lymph node involvement and hematogenous dissemination leading to fever, myalgia, decreased appetite, and vomiting.
- Photosensitivity in up to 35% occurring 1 to 2 months after bubo formation.
- Bubo: painful inflammation of lymph node, unilateral enlargement, suppuration, and abscesses.
- Meningoencephalitis, hepatosplenomegaly, arthralgia, and iritis are less common.
- Lymphadenitis episodes resolve spontaneously in 8 to 12 weeks.
32
What is the significance of the 'groove sign' in the diagnosis of LGV?
The 'groove sign' refers to nodal enlargement on either side of the inguinal ligament, which is pathognomonic of LGV. However, it only presents in 10% to 20% of cases and is rarely bilateral.
33
What are the laboratory tests used to confirm Lymphogranuloma Venereum (LGV)?
34
What are the specific tests used for identifying Lymphogranuloma Venereum (LGV)?
- Confirmation of LGV requires identification of the genotype L1, L2, or L3.
- **Nucleic acid amplification tests (NAAT)**, like **PCR**, are performed on all specimens and are the diagnostic method of choice.
- Methods for typing include genotype-specific PCRs, multiplex-nested PCR, and RFLP or sequence analysis of omp1 gene regions.
35
What are the common complications associated with untreated anorectal syndrome in LGV?
- Rectal strictures (most common) and abscesses.
- Perineal sinuses.
- Rectovaginal fistulae (watering can perineum).
- Lymphorrhoids, which are perianal outgrowths of lymphatic tissue.
36
A 35-year-old man presents with painful unilateral lymph node enlargement and erythematous skin overlying the node. What is the likely diagnosis and the next step in management?
The likely diagnosis is lymphogranuloma venereum (LGV) with bubo formation. The next step is to confirm the diagnosis with a lymph node aspirate and nucleic acid amplification test (NAAT) for C. trachomatis.
37
A woman presents with low abdominal pain exacerbated when lying supine. She has a history of untreated genital ulcer. What is the likely complication and its pathophysiology?
The likely complication is pelvic adhesions due to lymphatic drainage of the vagina and cervix to deep pelvic/retroperitoneal lymph nodes, leading to inflammation and adhesions.
38
A 28-year-old MSM presents with symptoms mimicking Crohn's disease, including diarrhea and rectal pain. What condition should be ruled out and why?
LGV proctitis should be ruled out because it mimics chronic inflammatory bowel disease both clinically and pathologically.
39
A patient with LGV has developed rectal strictures and perineal sinuses. What stage of LGV is this, and what are the common sequelae?
This is the tertiary stage of LGV. Common sequelae include rectal strictures, abscesses, perineal sinuses, and rectovaginal fistulae.
40
A patient with suspected LGV has a positive NAAT for C. trachomatis. What additional test is required to confirm LGV, and why?
A genotype-specific PCR or sequencing of the omp1 gene region is required to confirm LGV, as NAAT does not provide information about the underlying genotype.
41
A 40-year-old woman presents with progressive genital destruction and lymphangitis. What rare LGV complication is likely, and what is its name?
The likely complication is esthiomene, a rare primary infection of the external genitalia characterized by progressive lymphangitis and genital destruction.
42
A patient with LGV is HIV-positive. How does this affect the clinical presentation and treatment duration?
The clinical features do not differ between HIV-positive and HIV-negative cases. However, treatment duration may need to be prolonged until complete resolution of all signs and symptoms.
43
A patient presents with conjunctivitis and preauricular lymphadenopathy after autoinoculation of infected discharges. What is the likely diagnosis?
The likely diagnosis is ocular LGV, which may lead to conjunctivitis with marginal corneal perforation.
44
What are late sequelae of the genital syndrome of LGV?
Late sequelae of the genital syndrome are less common and inclued urethral strictures and genital elephantiasis with ulcers and fistulas (4%).
45
A patient with LGV has a painful, immovable mass in the inguinal region. What is this mass called, and what is its pathophysiology?
The mass is called a bubo, caused by lymph node enlargement, suppuration, and abscess formation.
46
What does the groove sign indicate in a patient with LGV, and how common is it?
The groove sign indicates nodal enlargement on either side of the inguinal ligament and is pathognomonic of LGV, occurring in 10-20% of cases.
47
What are the potential long-term complications for a patient with LGV and a history of untreated anorectal syndrome?
Potential complications include rectal strictures, abscesses, perineal sinuses, and infertility due to ruptured deep pelvic nodes.
48
What diagnostic method can detect a mixed infection of LGV and non-LGV strains?
A real-time quadriplex PCR assay can detect LGV, non-LGV, or mixed infections simultaneously.
49
What are the common clinical features observed in the secondary stage of Lymphogranuloma Venereum (LGV)?
- Marked lymph node involvement and hematogenous dissemination leading to fever, myalgia, decreased appetite, and vomiting.
- Photosensitivity in up to 35% of cases.
- Bubo formation characterized by painful inflammation of lymph nodes, unilateral enlargement, suppuration, and abscesses.
- Meningoencephalitis, hepatosplenomegaly, arthralgia, and iritis are less common.
- Lymphadenitis episodes resolve spontaneously in 8 to 12 weeks.
50
What is the significance of the 'groove sign' in the diagnosis of LGV?
The 'groove sign' refers to nodal enlargement on either side of the inguinal ligament, which is pathognomonic of LGV but only presents in 10% to 20% of cases. It is a key clinical indicator in diagnosing LGV, particularly in men.
51
What are the common presentations of acute anorectal syndrome in LGV?
- Perirectal nodal involvement and acute hemorrhagic proctitis.
- Symptoms include anal pruritus, bloody and/or purulent rectal discharge, tenesmus, diarrhea, constipation, and lower abdominal pain.
- Most common in women and homosexual men who practice anal sex, with a significant outbreak reported in MSM.
52
How does LGV present differently in men and women during the secondary stage?
In men, LGV typically presents with inguinal and/or femoral lymph node involvement, while in women, inguinal lymphadenitis is unusual due to the lymphatic drainage patterns. Women may experience low abdominal/back pain due to pelvic adhesions.
53
What are the potential complications associated with untreated LGV in the tertiary stage?
- Rectal strictures and abscesses.
- Perineal sinuses and rectovaginal fistulae.
- Lymphorrhoids, which are perianal outgrowths of lymphatic tissue.
- Rarely, esthiomene, which is a primary infection of the external genitalia leading to progressive lymphangitis and genital destruction.
54
What laboratory tests are used to confirm a diagnosis of LGV?
- Specific tests for LGV include nucleic acid amplification tests (NAAT) to identify the genotype L1, L2, or L3.
- Positive test results from lymph node aspirate are considered diagnostic for LGV.
- A dual target PCR assay can differentiate between LGV and non-LGV strains.
55
What is the role of non-specific chlamydial tests in the diagnosis of LGV?
Non-specific chlamydial tests, such as the complement fixation test, are commonly used but have limitations. Titers below 1:32 exclude the diagnosis unless the infection is in its early stages, while titers greater than 1:64 are considered diagnostic, and titers greater than 1:256 are highly suggestive of LGV.
56
What are the clinical implications of reactive arthritis in MSM following LGV proctitis?
Reactive arthritis can occur in MSM following LGV proctitis, indicating a potential systemic response to the infection. This highlights the need for comprehensive management of LGV to prevent long-term complications such as arthritis.
57
What are the late sequelae of genital syndrome in LGV?
Late sequelae of genital syndrome in LGV may include urethral strictures, genital elephantiasis with ulcers and fistulas (4%), and penile deformities such as saxophone penis.
58
What is the significance of identifying the genotype of C. trachomatis in LGV treatment?
Identifying the genotype of C. trachomatis is crucial because the recommended antibiotic treatment for LGV is longer than for non-LGV cases. This ensures appropriate management and reduces the risk of complications.
59
What is the significance of the microimmunofluorescence test for L-type serovar in diagnosing LGV?
The microimmunofluorescence test for the L-type serovar is more sensitive and specific compared to other tests, but it is less readily available.
60
What are the recommended diagnostic procedures for confirming LGV?
1. Proctoscopic examination to identify superficial ulcerations and friable granulation tissue.
2. Detection of C. trachomatis genotypes specific for LGV using laboratory methods.
3. PCR-based assays preferred over culture due to higher sensitivity.
4. Anorectal and genital swabs from suspicious lesions or bubo aspirates are suitable clinical materials.
61
What are the histopathological findings associated with LGV?
- Primary lesions show nonspecific ulceration with granulation tissue and endothelial swelling.
- Lymph nodes exhibit suppurative granulomatous inflammation, which may enlarge into stellate abscesses.
- Not specific to LGV, as similar findings can occur in other conditions like cat-scratch disease and syphilitic proctocolitis.
62
What are the differential diagnoses for LGV proctitis?
1. Chancroid ulcers, which are usually larger and more painful.
2. Donovanosis (granuloma inguinale) ulcers, characterized by abundant friable granulation tissue without associated lymphadenitis.
3. Crohn's disease, which may present with similar proctoscopic findings but is more proximally localized.
63
What are the treatment options for LGV?
1. Doxycycline, 100 mg 2x/day for 3 weeks is the treatment of choice.
2. Azithromycin, 1 to 1.5 g 1x/week for 3 weeks when doxycycline is contraindicated.
3. Erythromycin base, 500 mg QID for 3 weeks as a third-line option.
4. Surgical intervention may be required in late stages for complications such as fistula formation or abscess drainage.
64
What preventive measures are recommended for LGV?
1. Periodic evaluation of high-risk individuals and health education.
2. Community and clinician awareness of LGV and availability of specific diagnostic tests.
3. Tracing and treating all sexual contacts of individuals diagnosed with LGV.
4. Testing individuals who had sexual contact with a patient diagnosed with LGV within 60 days prior to symptom onset.
65
What condition should be suspected in a patient presenting with rectal pain, bloody discharge, and tenesmus after unprotected anal intercourse?
Suspect LGV proctitis. Perform a proctoscopic examination and collect anorectal swabs for PCR-based assays to detect C. trachomatis genotypes specific for LGV.
66
What does a high complement fixation titer indicate in a patient with LGV?
A high complement fixation titer supports the diagnosis of LGV but does not differentiate current from prior infection due to cross-reactivity with other chlamydial infections.
67
What other conditions should be considered in the differential diagnosis for a patient with LGV proctitis showing crypt distortion and submucosal fibrosis?
Consider syphilitic proctocolitis and Crohn's disease, as they have similar histopathological findings.
68
What surgical interventions might be required for a patient with LGV who has developed a rectovaginal fistula?
Surgical interventions may include rectovaginal fistula repair, abscess drainage, and possibly colostomy.
69
What should be considered if a patient with LGV treated with doxycycline continues to have symptoms?
Consider prolonging the treatment duration and ensuring complete resolution of all signs and symptoms, especially in HIV-positive patients.
70
Why is the Frei test no longer commonly used in LGV diagnosis?
The Frei test is no longer used due to its low sensitivity and specificity, as it cross-reacts with other chlamydial serovars.
71
What genetic predisposition is associated with reactive arthritis in patients with LGV?
Reactive arthritis in LGV is associated with HLA-B27 positivity.
72
What is the recommended dosage and duration for azithromycin treatment in LGV?
The recommended dosage is 1 to 1.5 g of azithromycin once weekly for 3 weeks.
73
What are the limitations of serology assays in diagnosing LGV?
Serology assays are sensitive but nonspecific due to cross-reactivity with other chlamydial infections and do not differentiate between current and prior infections.
74
What diagnostic procedures are recommended for confirming LGV?
Proctoscopic examination and PCR-based assays are preferred for confirming LGV, with anorectal swabs and genital swabs being suitable clinical materials.
75
What histopathological findings are associated with LGV?
Histopathological findings include nonspecific ulceration with granulation tissue, endothelial swelling, and suppurative granulomatous inflammation in lymph nodes.
76
How can LGV be differentiated from other conditions like Crohn's disease?
Both LGV and Crohn's disease can present with similar proctoscopic findings, but Crohn's disease is more proximally localized, while LGV is associated with specific symptoms and signs.
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What are the potential complications associated with LGV?
Complications include acquisition and transmission of bloodborne pathogens such as HIV and hepatitis C, and an association with sexually acquired reactive arthritis in HLA-B27 positive individuals.
78
What is the recommended treatment for LGV?
The first-line treatment for LGV is doxycycline, 100 mg twice daily for 3 weeks. Alternatives include azithromycin and erythromycin, especially for pregnant women.
79
What is the prognosis for patients treated early for LGV?
If antibiotics are given early, the prognosis is curative, with acute anorectal syndrome responding more dramatically than acute genital syndrome.
80
What preventive measures should be taken for high-risk individuals regarding LGV?
Preventive measures include periodic evaluation, health education, tracing and treating sexual contacts, and testing individuals who have had sexual contact with LGV patients within 60 days of symptom onset.
81
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LGV proctocolitis shows crypt distortion, submucosal fibrosis, follicular inflammation, and occasional granuloma formation, while syphilitic proctocolitis has different histological features.
82
What role does direct fluorescence microscopy play in diagnosing LGV?
Direct fluorescence microscopy using conjugated monoclonal antibodies against C. trachomatis can help identify the presence of the bacteria in smears from bubo material or genital swabs.
83
What is the importance of antibody-negative results in serology for LGV diagnosis?
Antibody-negative results have a high negative predictive value, largely ruling out LGV, as the inguinal stage usually takes several weeks to appear.
84
How does the treatment duration for LGV compare to other serovars of C. trachomatis?
Treatment for LGV serovars is longer compared to other less-invasive serovars of C. trachomatis, requiring careful management.
85
What are the clinical implications of a high complement fixation titer against C. trachomatis?
A high complement fixation titer against C. trachomatis supports the diagnosis of LGV but does not provide definitive proof.
86
What is the significance of the Frei test in the context of LGV?
The Frei test was the earliest diagnostic modality for LGV, assessing delayed hypersensitivity to chlamydial antigens, but is no longer used due to low sensitivity and specificity.
87
What are the recommended actions for individuals who have had sexual contact with a patient diagnosed with LGV?
Individuals who have had sexual contact with a patient diagnosed with LGV within 60 days should be examined and tested for chlamydial infection and presumptively treated with a Chlamydia regimen.
88
What are the characteristics of the lesions found in LGV?
Primary lesions in LGV are characterized by nonspecific ulceration with granulation tissue and endothelial swelling, often leading to suppurative granulomatous inflammation in lymph nodes.
89
What is the role of serology in the diagnosis of LGV when no epithelial lesions are present?
If no epithelial lesions are present and lymph node aspirates cannot be obtained, serology may be applied for evaluation, although it is not definitive.
90
What are the clinical findings that suggest LGV proctitis in HIV-positive MSM?
In HIV-positive MSM, signs and symptoms of LGV proctitis may mimic those of Crohn's disease or malignancy, making clinical suspicion important even in the absence of pathognomonic findings.
91
What is the significance of the association between LGV and sexually acquired reactive arthritis?
The association between LGV and sexually acquired reactive arthritis in HLA-B27 positive individuals highlights the need for awareness and potential screening in affected populations.
92
What are the recommended surgical interventions for late-stage LGV?
Surgical interventions may include lateral aspiration of buboes, direct incision, rectal stricture dilation, abscess drainage, and colostomy, depending on the severity of the condition.
93
What are the differences in the clinical response to treatment of acute genital syndrome and acute anorectal syndrome in LGV?
Acute anorectal syndrome tends to respond more dramatically to treatment compared to acute genital syndrome.
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Community awareness of LGV, including health education and the availability of specific diagnostic tests, is crucial for early recognition and prevention of the disease.
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False-positive results in serological tests can lead to misdiagnosis and unnecessary treatment, emphasizing the need for confirmatory testing and clinical correlation.
96
How does the presence of friable granulation tissue aid in the diagnosis of LGV?
The presence of abundant friable granulation tissue, especially in the context of proctitis, is a key clinical finding that suggests LGV, particularly in high-risk populations.
97
What are the potential risks associated with the use of doxycycline in pregnant women for LGV treatment?
Doxycycline is avoided in the second and third trimesters of pregnancy due to the risk of discoloration of teeth and bones, necessitating alternative treatments like azithromycin or erythromycin.
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Differentiating LGV from other sexually transmitted infections is crucial for appropriate treatment and management, as well as for preventing complications and transmission.
99
What are the key features of the lesions associated with Donovanosis compared to LGV?
Donovanosis lesions are characterized by abundant friable granulation tissue without associated lymphadenitis, contrasting with LGV, which often presents with lymphadenopathy.
100
What is the significance of high serum levels of immunoglobulin A and G in the context of LGV?
High serum levels of immunoglobulin A and G can indicate an immune response to infection, but they are nonspecific and may not directly confirm LGV diagnosis.
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Patients treated for LGV should be monitored for resolution of signs and symptoms, and sexual activity should be avoided until
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LGV is characterized by abundant friable granulation tissue without associated lymphadenitis, contrasting with LGV, which often presents with lymphadenopathy.
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Patients treated for LGV should be monitored for resolution of signs and symptoms, and sexual activity should be avoided until complete resolution is achieved.
104
What is the role of PCR-based assays in the diagnosis of LGV?
PCR-based assays are preferred for detecting C. trachomatis in LGV due to their higher sensitivity compared to culture methods, aiding in accurate diagnosis.
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Screening in asymptomatic patients cannot be recommended.
106
What follow-up testing is suggested after an LGV diagnosis to exclude reinfections?
Retesting by nuclear amplification tests, including tests for HIV, syphilis, and hepatitis C, should be offered during a follow-up test 3 months after an LGV diagnosis.
107
What are the primary stage differential diagnoses for Lymphogranuloma Venereum?
Primary stage differential diagnoses include:
- Ulcerogenic diseases (herpes simplex virus, syphilis, chancroid, gonorrhea)
- Non-chlamydial urogenital infection
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What are the secondary stage differential diagnoses for Lymphogranuloma Venereum?
Secondary stage differential diagnoses include:
- Acute genital syndrome
- Ulcerogenic diseases (syphilis, chancroid, herpes simplex virus)
- Incarcerated inguinal hernia
- Reactive inguinal lymphadenitis
- AIDS
- Kaposi sarcoma
- Tuberculosis
- Tropical infections
- Acute anaphylactic syndrome
- Inflammatory bowel disease
- Lymphoma
- Infectious mononucleosis
- Cat-scratch disease
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What are the tertiary stage differential diagnoses for Lymphogranuloma Venereum?
Tertiary stage differential diagnoses include:
- Malignancy
- Filariasis and other parasitic infections
- Pseudoelephantiasis of lymphadenitis of tuberculosis and donovanosis
- Deep fungal infection
- Hidradenitis suppurativa
- Trauma
110
What is the first-line treatment for Lymphogranuloma Venereum?
The first-line treatment for Lymphogranuloma Venereum is oral doxycycline at a dose of 100 mg twice daily for 3 weeks.
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What is the second-line treatment for Lymphogranuloma Venereum?
The second-line treatment for Lymphogranuloma Venereum is oral azithromycin at a dose of 1 to 1.5 g once weekly for 3 weeks.
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What is the third-line treatment for Lymphogranuloma Venereum?
The third-line treatment for Lymphogranuloma Venereum is oral erythromycin at a dose of 500 mg 4 times daily for 3 weeks.
