Lymphogranuloma venereum

  • Etiology
    • Invasive genovar C. trachomatis L
  • Incubation
    • 1-4 weeks
  • Apresentação clínica
    • 3 stages
      • Primary ulcerative stage
      • Secondary loco-regional invasion (bulboes and fistulae)
        • Groove sign - inguinal lymph nodes (above the ligament) and femoral lymph nodes (below) separated by the inguinal ligament - specific of LGV
            • notion image
      • Tertiary (fibrotic/lymphedema)
    • Mostly present as acute proctitis (95%), ano-rectal pain, muco-purulent discharge, tenesmus, constipation, bloody stools, high fever, asymptomatic in 25% of cases
    • Tricky diagnosis (Crohn, lymphoma)
    • Sometimes chancre (5%), painful, papular or pustular, herpetiform erosion, erysipelas-like bubo
  • Epidemiology
    • Had disappeared from Western World
    • 2-10% of GUD in SE Asia and Central Africa
    • First case in Rotterdam MSMs 2003 and subsequent spread in Western world MSMs
    • 90% MSM
    • >50% HIV pos
  • Diagnosis
    • PCR CT pos and discriminatory NAAT/genotyping L (subvariant L2b)
  • Treatment
    • Doxycycline 100mg 2id orally x 21 days
      • Many recurrences reported if treatment is not continued for the 21 days
    • If another regiment is given (azithromycin): test of cure