Chapter 173 - LGV

Question 1

LGV is a sexually transmitted infection caused by

Answer 1

L serovars of Chlamydia trachomatis

Question 2

Peak incidence of LGV occurs in sexually active persons ages

Answer 2

15-40 years old

Question 3

Men are __ times more likely than women to manifest clinical infection

Answer 3

6

Question 4

Major predisposing factor for LGV in MSM

Answer 4

Fisting

Question 5

Only __% were asymptomatic

Answer 5

6

Question 6

Infectivity in men ceases after healing of primary mucosal lesion.
True or False

Answer 6

True

Question 7

Other names for LGV (3)

Answer 7

Tropical/climactic bubo
Lymphopathia venerea
Nicolas-Favre disease

Question 8

LGV serovars are more invasive and have high affinity for ___

Answer 8

Macrophages

Question 9

3 clinical stages characterize LGV (3)

Answer 9

Primary stage
Secondary stage
Tertiary stage

Question 10

In males, lesion is usually found in (3)

Answer 10

Coronal sulcus
Prepuce
Glans penis

Question 11

In females, lesion is usually found in (3)

Answer 11

Posterior wall of vagina
Vulva
Cervix

Question 12

Secondary stage of LGV often resolves spontaneously in ___ weeks

Answer 12

8-12

Question 13

Inguinal and or femoral LN involvement and is the major presentation in developing countries

Answer 13

Acute genital/inguinal syndrome

Question 14

Bilateral involvement of LGV occurs in __ of cases

Answer 14

1/3

Question 15

Pathognomonic of LGV

Answer 15

Groove sign

Question 16

Groove sign is usually bilateral.

True or False

Answer 16

False, rarely

Question 17

Inguinal lymphadenitis is rare in females as lymphatic drainage of vagina and cervix drains to ___

Answer 17

Deep pelvic/retroperitoneal lymph nodes

Question 18

Characterized by perirectal nodal involvement, acute hemorrhagic proctitis, and pronounced systemic symptoms

Answer 18

Acute anorectal syndrome

Question 19

MC presentation in women and in homosexual men who practice anal sex

Answer 19

Acute anorectal syndrome

Question 20

Major source of rectal spread in women is

Answer 20

Internal lymphatic drainage in lower 2/3 of vagina

Question 21

Watering can perineum

Answer 21

Rectovaginal fistula

Question 22

Perianal outgrowths of lymphatic tissue

Answer 22

Lymphorrhoids

Question 23

Rare primary infection of externa genitalia leading to progressive lymphangitis, genital destruction,

Answer 23

Esthiomene

Question 24

Sequelae of ruptured deep pelvic nodes (2)

Answer 24

Infertility

Frozen pelvis

Question 25

Accuracy of clinical diagnosis is __%

Answer 25

20

Question 26

A positive test on LN aspirate is considered diagnostic of LGV. True or False

Answer 26

True

Question 27

Confirmation of LGV requires identification of

Answer 27

Genotype L1, L2, L3

Question 28

Specific tests for LGV uses the ff genes to differentiate from non LGV strains

Answer 28

pmpH or omp1

Question 29

Specific tests for LGV

Answer 29

Real time quadriplex PCR | High resolution melting analysis

Question 30

Most commonly used nonspecific chlamydial tests

Answer 30

Complement fixation test

Question 31

In complement fixation test, titers greater than ___ are considered disgnostic

Answer 31

1:64

Question 32

In complement fixation test, titers greater than ___ are considered highly suggestive

Answer 32

1:256

Question 33

In complement fixation test, titers below ___ exclude the diagnosis

Answer 33

1:32

Question 34

Examples of nonspecific chlamydial tests

Answer 34

``` Complement fixation test Microimmunofluorescence test Direct fluorescence microscopy Serology assays Frei test ```

Question 35

Earliest diagnostic modality to identify LGV consist of ID skin test assessing delayed hypersensitivity to chlamydial antigens

Answer 35

Frei test

Question 36

Frei test is no longer used due to its low sensitivity and cross reactivity with serovars

Answer 36

D to K

Question 37

In contrast to LGV, __ ulcers are more painful and larger, and ___ ulcers have abundant friable granulation tissue without associated lymphadenitis.

Answer 37

Chancroid | Donovanosis

Question 38

Proctoscopic exam reveals

Answer 38

Multiple discrete and irregular ulcerations and friable granulation tissue confined to distal 10 cm of anorectal canal

Question 39

Treatment for LGV

Answer 39

1st: Doxycycline 100 mg PO BID 2nd: azithromycin 1-1.5g PO once weekly for 3 weeks 3rd: Erythromycin 500mg QID for 3 weeks

Question 40

Pregnant and lactating women should be treated with

Answer 40

Azithromycin or Erythromycin

Question 41

Doxycycline should be avoided in the ___ trimester of pregnancy

Answer 41

2nd to 3rd

Question 42

Persons who had sexual contacts with a patient who had LGV in ___ days before onset of symptoms

Answer 42

60

Question 43

To exclude reinfection, retesting by nuclear amplification during ff up after ___ should be offered

Answer 43

3 months