Lymphogranuloma venereum

Organism

Lymphogranuloma venereum (LGV) is caused by Chlamydia trachomatis (C. trachomatis) serotypes L1 – L3, which differ from those that cause urethritis or cervicitis. LGV has recently been acquired locally so can no longer be seen as only an imported disease.

Clinical presentation

The initial lesion is a transient ulcer that usually appears 3 to 10 days after infection. This may go unnoticed, and most patients present some weeks later with inguinal lymphadenopathy, which may progress to form a fluctuant bubo by the time the patient is seen. It may also present as painful proctitis and should be suspected in MSM with ano-rectal symptoms.

Investigations
  • Demonstration by NAAT of C. trachomatis in fluid aspirated from a fluctuant bubo.
  • Serology – the LGV complement fixation test (LGV-CFT) is the most widely available serological test. Titres > 1:64 are highly suggestive of LGV in a patient with a compatible clinical picture.
  • Specific testing for rectal LGV for C. trachomatis NAAT positive samples is available on request from PathWest and RPH. All positive rectal chlamydia samples should be sent for confirmatory testing.
Treatment

Standard

  • Doxycycline 100 mg orally, 12-hourly for 21 days or longer

        or

  • roxithromycin 300 mg once daily for 21 days or longer

        or

  • erythromycin ethyl succinate 800 mg orally, 12-hourly for 21 days or longer.

Special consideration

Azithromycin 1 g orally weekly for three weeks (for MSM and HIV antibody positive patients). Data on the efficacy of weekly azithromycin is scanty.

Pregnancy

  • Erythromycin ethyl succinate 800 mg orally, 12-hourly for 21 days or longer (category A).
  • Medicines in pregnancy.

Doxycycline is contraindicated in pregnancy.

Related links


Management of partners

Current partners and partners over the previous six months should be assessed and offered STI screening and empirical LGV treatment.

Follow up
  • Consider other STIs.
  • Retesting should occur four weeks after antibiotics have been completed.
Public health issues

This is a notifiable disease.

Contact tracing is important to prevent further infection and treat contacts.

Always test for other STIs.

Notification

This is a notifiable infection. Medical practitioners must complete the appropriate notification forms for all patients diagnosed with a notifiable STI/HIV, as soon as possible after confirmed diagnosis.