Makindo Medical Notes

Also screen for HIV, gonorrhea, and syphilis.

About

• Lymphogranuloma Venereum (LGV) is a sexually transmitted infection caused by certain strains of Chlamydia trachomatis.
• It is important to screen for other STDs, including HIV, gonorrhea, and syphilis, as co-infections are common.

Aetiology

• Caused by Chlamydia trachomatis serovars L1, L2, L2a, L2b, or L3.
• Transmitted through sexual contact, particularly unprotected anal, oral, or vaginal sex.

Clinical

• Presents with genital ulceration often accompanied by tender inguinal or femoral lymphadenopathy.
• Can cause proctocolitis, which may mimic inflammatory bowel disease.
• Complications include chronic colorectal fistulas and strictures if left untreated.

Investigations

• Perform HIV test and general screening for other STDs like gonorrhea and syphilis.
• Confirm C. trachomatis infection through culture or nucleic acid amplification tests (NAAT).
• PCR can differentiate between LGV and non-LGV strains of C. trachomatis.
• Chlamydia serology (complement fixation titers >1:64 or microimmunofluorescence titers >1:256) may support the diagnosis of LGV in the appropriate clinical context.

Management

• Screen, test, and treat sexual contacts to prevent spread.
• Doxycycline 100 mg orally twice a day for 21 days is the first-line treatment (not recommended in pregnancy).
• Alternative treatment: Erythromycin base 500 mg orally four times a day for 21 days.
• Azithromycin 1 g orally once weekly for 3 weeks is another alternative.
• Follow-up is recommended to ensure symptom resolution and manage potential complications.

References

• CDC: Lymphogranuloma Venereum (LGV) Treatment Guidelines
• WHO: Sexually Transmitted Infections (STIs)