Lymphogranuloma venereum (LGV) - Climatic bubo

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This is a chronic infection of the lymphatic system

Causes

  • Chlamydia trachomatis (serotypes L1, L2, L3) 

1st Stage LGV (3-30 days)

Lesions occur in form of small painless papule, pustule, nodule shallow erosion or herpetiform ulcer on the posterior vaginal wall, vulva, cervix or rectum, and on the coronal sulcus in men

There may be muco-purulent  discharge from the urethra, vagina or rectum

 

2nd stage LGV  (2-6 weeks)

Inguinal syndrome (painful inguinal lymph nodes) mostly in men (unilateral/bilateral enlargement, inflammation, suppuration and abscesses)

Anorectal syndrome -receptive anal sex (proctitis, pain during urination, rectal bleeding, pain during passing stools, abdominal pain, anal pain)

Intra-abdominal or retroperitoneal lymphadenopathy (low abdominal pain)

Systemic presentation (fever, chills, malaise, myalgias, and arthralgias.

3rd stage (genito-anorectal syndrome/anogenitorectal syndrome

Mainly in women but also in homosexual men (chronic inflammation, perirectal abscess, anal fistulas, strictures and stenosis of rectum, lymphorroids, chronic penile and scrotal oedema

Differential diagnosis

  • Chancroid
  • Colitis
  • Granuloma inguinale
  • Herpes simplex, syphilis

Complications

  • Necrosis and rupture of lymph nodes
  • Anogenital fibrosis and strictures
  • Anal fistulae
  • Elephantiasis of genital organ
  • Systemic complications (pneumonia, hepatitis)

Investigations

  • Serology tests - complement fixation, immunofluorescence

Treatment objectives

  • Eradicate the causative organism
  • Prevent complications

Pharmacological treatment

Adult:

Doxycycline

100 mg two times daily for 14-21 days

OR

Erythromycin oral

500 mg four times daily for 14-21 days

OR

Azithromycin 500mg oral for 14-21 days

Pregnant and lactating female

Erythromycin oral

500 mg four times daily for 21 days

OR

Azithromycin 500mg oral for 14-21 days

HIV patient

Treat the same as HIV-negative patients, but for longer  

Sex partners exposed to patient in the last 60 days

Doxycycline oral

100 mg two times daily for 7 days

OR

Azithromycin 500mg daily for 14-21 days

OR

Erythromycin oral

500 mg four times daily for 14-21 days

Prevention

  • Advise patient to use condom during sexual intercourse

Referral

  • If no improvement after the above treatment refer for specialist care