26 - 173 - LYMPHOGRANULOMA VENEREUM Flashcards
Lymphogranuloma venereum is a sexually transmitted infection caused by L serovars (serologic variants) of what bacteria
Chlamydia trachomatis
most common presentation in women and in homosexual men who practice anal sex
acute anorectal syndrome is characterized by perirectal nodal involvement, acute hemorrhagic proctitis, and pronounced systemic symptoms
major presentation in men in developing countries
acute genital syndrome or inguinal syndrome is characterized by inguinal and/or femoral lymph node involvement
pathognomonic of LGV
Nodal enlargement on either side of the inguinal ligament, the** “groove sign,”**
diagnostic method of choice in recent outbreaks of LGV
Nucleic acid amplification tests (NAAT)
what are the 3 stages of LGV
1. PRIMARY STAGE
* 3 - 30 days after infection, 5- to 8-mm painless (difference from herpetic lesions), erythematous papule(s) or small herpetiform ulcers appear at the site of inoculation
* Less common: Painful ulcerations and nonspecific urethritis
* AOP (males): coronal sulcus, prepuce, or glans penis
* AOP (females): posterior wall of the vagina, vulva, or, occasionally, the cervix
* Inoculation also may be rectal, at the lip, or pharyngeal
* Primary lesion is transient, often heals within a few days, and may go unnoticed
2. SECONDARY STAGE
* few weeks after the primary lesion appears
* marked lymph node involvement and hematogenous dissemination occur manifested by fever, myalgia, decreased appetite, and vomiting
* Photosensitivity may develop in up to 35%, often 1 to 2 months after bubo formation
* Less common: may develop meningoencephalitis, hepatosplenomegaly, arthralgia, and iritis
* lymphadenitis episodes often resolve spontaneously in 8 to 12 weeks
* 2 major syndromes are seen based on mode of transmission:
**Acute genital syndrome or inguinal syndrome: **inguinal and/or femoral lymph node involvement; overlying skin is erythematous and indurated; in 1 to 2 weeks, LN enlarges and and coalesces to form a firm and tender immovable mass (bubo); major presentation in men in developing countries
**Pathognomonic: “groove sign” **- nodal enlargement on either side of the inguinal ligament; present in 10 - 20% only and rarely bilateral
Acute anorectal syndrome - perirectal nodal involvement, acute hemorrhagic proctitis, and pronounced systemic symptoms; most common presentation in women and in homosexual men who practice anal sex
anal pruritus, bloody and/or purulent rectal discharge, tenesmus, diarrhea, constipation, and lower abdominal pain
3. TERTIARY STAGE
* seen more often in women with untreated anorectal syndrome than in men
* rectal strictures (most common) and abscesses, perineal sinuses, rectovaginal fistulae (leading to “watering can perineum”), and “lymphorrhoids” (perianal outgrowths of lymphatic tissue)
* Esthiomene rare primary infection of the external genitalia (mostly in women), leading to progressive lymphangitis and genital destruction
- most commonly used nonspecific chlamydial test
- what titers are diagnostic and highly suggestive?
complement fixation test
Titers > 1:64 - diagnostic
Titers > 1:256 - highly suggestive
Titers < 1:32 - exclude the diagnosis unless the infection is in its early stages
treatment of choice for LGV
Oral doxycycline, 100 mg twice daily for 3 weeks,
- When contraindicated, oral azithromycin, 1 to 1.5 g once weekly for 3 weeks or as a third-line erythromycin base, at a dose of 500 mg 4 times a day for 3 weeks, may be given
- Pregnant and lactating women can be treated with azithromycin or erythromycin.
