Lymphogranuloma venereum (LGV), a rare disease in the United States, is caused
by the invasive serovars L1, L2, or L3 of C. trachomatis.
The most frequent clinical manifestation of LGV among heterosexual men is
tender inguinal and/or femoral lymphadenopathy that is usually unilateral.
Women and homosexually active men might have proctocolitis or inflammatory
involvement of perirectal or perianal lymphatic tissues that can result in
fistulas and strictures.
When most patients seek medical care, they no longer have the self-limited
genital ulcer that sometimes occurs at the inoculation site.
The diagnosis usually is made serologically and by exclusion of other causes
of inguinal lymphadenopathy or genital ulcers.
Treatment cures infection and prevents ongoing tissue damage, although tissue
reaction can result in scarring. Buboes may require aspiration through intact
skin or incision and drainage to prevent the formation of inguinal/femoral
ulcerations. Doxycycline is the preferred treatment.
Doxycycline 100 mg orally twice a day for 21
Erythromycin base 500 mg orally four times a
day for 21 days.
The activity of azithromycin against C. trachomatis
suggests that it may be effective in multiple doses over 2-3 weeks, but clinical
data regarding its use are lacking.
Patients should be followed clinically until signs and symptoms have resolved.
Management of Sex Partners
Sex partners of patients who have LGV should be examined, tested for urethral
or cervical chlamydial infection, and treated if they had sexual contact
with the patient during the 30 days preceding onset of symptoms in the patient.
Pregnant women should be treated with the erythromycin regimen.
HIV-infected persons who have LGV should be treated according to the regimens
cited previously. Anecdotal evidence suggests that LGV infection in HIV-positive
patients may require prolonged therapy and that resolution might be delayed.