What is Lymphogranuloma Venereum (LGV)?
Lymphogranuloma Venereum is a sexually transmitted disease caused by the L1, L2, L3 subtypes of the Chlamydia Trachomatis.
Clinical presentation of Lymphogranuloma Venereum
Patient may present with genital ulcer and unilateral enlarged groin lymph nodes (Bubo) which may become fluctuant. Patients may also experience lower abdomen pain. In females they may experience dyspareunia (pain during sexual intercourse). Some patients may have colitis (inflammation of the colon), anal fissures, anal strictures and also peri-anal inflammation.
Diagnostic Tests of Lymphogranuloma Venereum
1.Lymph node aspirates can be sent for culture of the chlamydia organism.
2.LGV CFT serologic tests’ titer of 1:16 or more OR rising titer over 2 weeks is significant to conclude LGV infection
3.PCR tests for LGV
The enlarged infected lymph nodes (Bubo) can be aspirated to prevent chronic sinus formation. The ulcers can be cleansed with anti-septic solution or normal saline.
Treatment of Lymphogranuloma Venereum
The recommended oral antibiotics used for treatment are:
1.Oral erythromycin 500 mg 4 times daily for 3 weeks OR
2.Oral doxycycline 100 mg twice daily for 3 weeks.
If patients are unable to tolerate the above medications, other alternative antibiotics are:
1.Oral azithromycin 1 gram weekly for 3 weeks Or
2.Oral Tetracycline 500 mg 4 times daily for 3 weeks.
Tetracycline and doxycycline are contraindicated in pregnant women. They can be treated with erythromycin and azithromycin.
Treatment should be continued until the clinical picture improves. HIV patients with LGV may need longer course of treatment.
Sexual contact 30 days prior to onset of symptoms should be contacted examined and treated if indicated.