Chapter 173 - LGV Flashcards
LGV is a sexually transmitted infection caused by
L serovars of Chlamydia trachomatis
Peak incidence of LGV occurs in sexually active persons ages
15-40 years old
Men are __ times more likely than women to manifest clinical infection
6
Major predisposing factor for LGV in MSM
Fisting
Only __% were asymptomatic
6
Infectivity in men ceases after healing of primary mucosal lesion.
True or False
True
Other names for LGV (3)
Tropical/climactic bubo
Lymphopathia venerea
Nicolas-Favre disease
LGV serovars are more invasive and have high affinity for ___
Macrophages
3 clinical stages characterize LGV (3)
Primary stage
Secondary stage
Tertiary stage
In males, lesion is usually found in (3)
Coronal sulcus
Prepuce
Glans penis
In females, lesion is usually found in (3)
Posterior wall of vagina
Vulva
Cervix
Secondary stage of LGV often resolves spontaneously in ___ weeks
8-12
Inguinal and or femoral LN involvement and is the major presentation in developing countries
Acute genital/inguinal syndrome
Bilateral involvement of LGV occurs in __ of cases
1/3
Pathognomonic of LGV
Groove sign
Groove sign is usually bilateral.
True or False
False, rarely
Inguinal lymphadenitis is rare in females as lymphatic drainage of vagina and cervix drains to ___
Deep pelvic/retroperitoneal lymph nodes
Characterized by perirectal nodal involvement, acute hemorrhagic proctitis, and pronounced systemic symptoms
Acute anorectal syndrome
MC presentation in women and in homosexual men who practice anal sex
Acute anorectal syndrome
Major source of rectal spread in women is
Internal lymphatic drainage in lower 2/3 of vagina
Watering can perineum
Rectovaginal fistula
Perianal outgrowths of lymphatic tissue
Lymphorrhoids
Rare primary infection of externa genitalia leading to progressive lymphangitis, genital destruction,
Esthiomene
Sequelae of ruptured deep pelvic nodes (2)
Infertility
Frozen pelvis
Accuracy of clinical diagnosis is __%
20
A positive test on LN aspirate is considered diagnostic of LGV.
True or False
True
Confirmation of LGV requires identification of
Genotype L1, L2, L3
Specific tests for LGV uses the ff genes to differentiate from non LGV strains
pmpH or omp1
Specific tests for LGV
Real time quadriplex PCR
High resolution melting analysis
Most commonly used nonspecific chlamydial tests
Complement fixation test
In complement fixation test, titers greater than ___ are considered disgnostic
1:64
In complement fixation test, titers greater than ___ are considered highly suggestive
1:256
In complement fixation test, titers below ___ exclude the diagnosis
1:32
Examples of nonspecific chlamydial tests
Complement fixation test Microimmunofluorescence test Direct fluorescence microscopy Serology assays Frei test
Earliest diagnostic modality to identify LGV consist of ID skin test assessing delayed hypersensitivity to chlamydial antigens
Frei test
Frei test is no longer used due to its low sensitivity and cross reactivity with serovars
D to K
In contrast to LGV, __ ulcers are more painful and larger, and ___ ulcers have abundant friable granulation tissue without associated lymphadenitis.
Chancroid
Donovanosis
Proctoscopic exam reveals
Multiple discrete and irregular ulcerations and friable granulation tissue confined to distal 10 cm of anorectal canal
Treatment for LGV
1st: Doxycycline 100 mg PO BID
2nd: azithromycin 1-1.5g PO once weekly for 3 weeks
3rd: Erythromycin 500mg QID for 3 weeks
Pregnant and lactating women should be treated with
Azithromycin or Erythromycin
Doxycycline should be avoided in the ___ trimester of pregnancy
2nd to 3rd
Persons who had sexual contacts with a patient who had LGV in ___ days before onset of symptoms
60
To exclude reinfection, retesting by nuclear amplification during ff up after ___ should be offered
3 months
