Lymphogranuloma venereum Flashcards
Define lymphogranuloma venereum.
STI caused by Chlamydia trachomatis serovars L1, L2 and L3.
NB: ‘Normal’ Chlamydia resulting in urethritis and pelvic inflammatory disease is caused by Chlamydia trachomatis serovars D through K.
What are the risk factors for LGV?
- MSM
- Majority of patients who present in developed countries have HIV
- Historically was seen more in the tropics
What is the pathophysiology of LGV vs chlamydia?
LGV - invades the lymphatic tissue
Chlamydia - affects the mucosal sites
What are the clinical features of LGV?
3 stages:
- Stage 1 - small painless pustule which later form an ulcer
- Stage 2 - painful inguinal lymphadenopathy +/- fistulating buboes
- Stage 3 - proctocolitis
What is shown?
LGV stage 1 pustule
How does LGV often present in MSM?
Proctocolitis
How do you diagnose LGV?
Swab +/- aspiration of bubo - NAAT or gram staining for identification of Chlamydia trichomatis
NB: specific diagnosis can only be made with LGV-specific testing like PCR based genotyping.
What is the management of LGV?
Doxycycline
What are the complications of LGV?
- Chronic inflammation -> scarring and fibrosis
- Formation of strictures or fistulae if anorectal involvement - may require stricture or fistula formation
- Reactive arthritis
- Chronic lymphoedema of the genitals - may require plastic reconstructive surgery
What is the prognosis with LGV?
Full recovery expected if treatment started early
