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Genital Herpes



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Lymphogranuloma Venereum

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.

Recommended Regimens
Doxycycline 100 mg orally twice a day for 21 days.

Alternative Regimens
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.

Special Considerations
Pregnant women should be treated with the erythromycin regimen.

HIV Infection
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.