Lymphogranuloma Venereum

Key Features

• An acute and chronic sexually transmitted disease

• Evanescent primary genital lesion

• Inguinal buboes with suppuration and draining sinuses

• Proctitis and rectal stricture in women on in men who have sex with men

• Positive complement fixation test

• Caused by Chlamydia trachomatis types L1–L3

Clinical Findings

• In men

  • The initial vesicular or ulcerative lesion (on the external genitalia) is evanescent and often goes unnoticed

  • Inguinal buboes appear 1–4 weeks after exposure, are often bilateral, and have a tendency to fuse, soften, and break down to form multiple draining sinuses, with extensive scarring

• In women

  • The genital lymph drainage is to the perirectal glands

  • Early anorectal manifestations are proctitis with tenesmus and bloody purulent discharge

• Late manifestations

  • Chronic cicatrizing inflammation of the rectal and perirectal tissue

    • These changes lead to obstipation and rectal stricture and, occasionally, rectovaginal and perianal fistulas

    • These changes are also seen in patients who have anal coitus

• Differential diagnosis

  • Syphilis

  • Genital herpes

  • Chancroid

  • Tularemia

  • Tuberculosis

  • Plague

  • Neoplasm

  • Pyogenic infection

  • Neoplasm

  • Ulcerative colitis

Diagnosis

• The complement fixation antibody testing may be positive (titers > 1:64), but cross-reaction with other chlamydiae occurs

• Nucleic acid detection tests are sensitive, but cannot differentiate lymphogranuloma venereum (LGV) from non-LGV strains

Treatment

• Doxycycline, 100 mg orally twice daily for 21 days; contraindicated in pregnancy

• Erythromycin, 500 mg orally four times daily for 21 days

• Azithromycin, 1 g orally once weekly for 3 weeks, may also be effective