Lymphogranuloma venereum: Difference between revisions
No edit summary |
|||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
* L1, L2, L3 serovars of [[Chlamydia trachomatis]] | * Cased by L1, L2, L3 serovars of [[Chlamydia trachomatis]]<ref name="Ceovic">Ceovic R, Gulin SJ. Lymphogranuloma venereum: diagnostic and treatment challenges. Infection and Drug Resistance. 2015;8:39-47. doi:10.2147/IDR.S57540.</ref> | ||
* Sexually transmitted | * Sexually transmitted | ||
* Often co-infected with [[HIV]] | * Often co-infected with [[HIV]] | ||
==Clinical Features== | ==Clinical Features<ref name="Ceovic" />== | ||
* | *Incubation period 3-30 days | ||
* | *Stage 1 (Primary): Self-limited painless genital papule/ulcer (lasts ~1 week) | ||
** Systemic: | **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) | ||
** Rectal pain, discharge, bleeding | **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== | ==Differential Diagnosis== | ||
| Line 19: | Line 25: | ||
* [[Granuloma inguinale]] | * [[Granuloma inguinale]] | ||
== | ==Diagnostic Evaluation== | ||
* NAAT or immunofluorescence | * Nucleic Acid Amplification Tests (NAAT) or immunofluorescence | ||
* Culture (Needle aspiration at bubo) | * Culture (Needle aspiration at bubo) | ||
* Seology | * Seology | ||
| Line 30: | Line 36: | ||
==Disposition== | ==Disposition== | ||
* Instruct patient to abstain from sexual activities | *Discharge | ||
*Instruct patient to abstain from sexual activities until completion of treatment | |||
==See Also== | ==See Also== | ||
| Line 36: | Line 43: | ||
*[[Chlamydia trachomatis]] | *[[Chlamydia trachomatis]] | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:ID]] | [[Category:ID]] | ||
Revision as of 01:21, 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) 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
- Discharge
- Instruct patient to abstain from sexual activities until completion of treatment