LGV

Question 1

Which C trachomatis serovar is the most common strain implicated in LGV infection?

Answer 1

L2

Question 2

What proportion of MSM are more likely to be HIV positive and have LGV compared with non-LGV chlamydia?

Answer 2

8.2 times more

Question 3

What are the 3 stages of LGV?

Answer 3

Primary lesion
Secondary lesion, lymphadenitis, lymphadenopathy or bubo
Tertiary stage OR Genito-anorectal syndrome

Question 4

LGV can be classified into how many stages?

Answer 4

3

Question 5

Primary LGV - incubation, symptoms/signs?

Answer 5

3-30 days
transient
painless papule, pustule, shallow ulcer or erosion

Question 6

Where is genital ulceration due to LGV in women?

Answer 6

posterior vaginal wall
fourchette
vulva
cervix (occasional)

Question 7

Where is genital ulceration due to LGV in men?

Answer 7

coronal sulcus

Question 8

What is the typical presentation of LGV proctitis?

Answer 8

rectal pain
anorectal bleeding
mucoid and/or haemopurulent rectal dis- charge
tenesmus
constipation

Question 9

C trachomatis serovars L1–L3 are lymphotropic, infecting lymphocytes and macrophages - describe the pathological process

Answer 9

thrombolymphangitis
perilymphangitis
regional dissemination characterised by inflammation and swelling of lymph nodes and surrounding tissue

Question 10

What complication may arise from buboes in LGV?

Answer 10

ulceration and discharge pus from multiple points creating chronic fistulae

Question 11

the ‘groove sign’ - what is it?

Answer 11

both inguinal and femoral lymph nodes enlarged they are noticeably separated by the inguinal ligament

Question 12

How common is the ‘groove sign’ in LGV?

Answer 12

15-20%

Question 13

What is the significance of the ‘groove sign’?

Answer 13

Pathognomonic of LGV

Question 14

When does lymphadenopathy typically occur following primary LGV?

Answer 14

10-30 days

Question 15

What is the pathological process in tertiary LGV?

Answer 15

persistence or progressive spread of C trachomatis
chronic inflammation and destruction of tissues
Proctitis
Proctocolitis mimicking Crohns
Fistulae
Strictures
Chronic granulomatous disfiguring fibrosis and scarring of the vulva

Question 16

How likely is tertiary LGV?

Answer 16

vast majority of patients recover after the secondary stage

Current LGV outbreak - complications are rare

Question 17

What is the potential long term sequelae of LGV?

Answer 17

genital lymphedema
persistent suppuration and pyoderma
association with rectal cancer

Question 18

What additional STIs should be considered if LGV is suspected?

Answer 18

check for co-existing STIs particularly

herpes, gonorrhoea, syphilis

Question 19

What level of PMNLs on rectal swab is predictive of LGV proctitis?

Answer 19

> 10 PMNLs per high-power field

Question 20

Which sites can be used for sample collection for LGV?

Answer 20

ulcer base exudate
rectal mucosa
aspiration of lymph node or bubo
swab or FVU for urethral sample

Question 21

What diagnostic techniques can be considered in LGV?

Answer 21

detection of DNA/RNA by NAAT
culture on cyclohgeximide-treated McCoy cells
Chlamydia serology

Question 22

What are the limitations of LGV culture?

Answer 22

lower sensitivity than NAAT
labour-intensive
expensive
restricted availability

Question 23

LGV lymphadenopathy - histology?

Answer 23

follicular hyperpla- sia and abscesses

non-specific but LGV should be on differential

Question 24

How do we identify LGV-associated serovars of C trachomatis?

Answer 24

Restriction fragment length polymorphism (RFLP) analysis sequencing

Question 25

ow quick should symptoms resolve following treatment for LGV?

Answer 25

within 1-2 weeks of starting therapy

Question 26

What is the preferred regimen for LGV treatment?

Answer 26

Doxycycline 100mg twice daily THREE weeks

Question 27

How far back should contact tracing be considered for LGV?

Answer 27

Symptoms - 4 weeks

Asymptomatic - 3 months