Wednesday, May 12, 2010
Lymphogranuloma venereum is a chronic sexually transmitted
infection that occurs in 3 stages. The primary stage is cervicitis,
proctitis, or a transient genital papule. The secondary stage is
bilateral inguinal or pelvic adenopathy. If untreated, lymphatic
damage can occur, resulting in genital fibrosis and lymphedema. The
tertiary stage is very difficult to manage, so identification of
infected patients at earlier stages is critical. There is an
ongoing epidemic of chlamydial proctitis in South Africa, Europe,
and the United States among men who have sex with men. The
diagnosis is difficult to confirm, as serologic tests do not
distinguish prior exposure. Newer tests identifying nuclear
components of the infectious agent are becoming available, and can
be performed on histological material.
- Doxycycline 100 mg twice daily for 3 weeks.
- Oral erythromycin 500 mg 4 times daily for 3 weeks.
- Initial anecdotal reports suggest that azithromycin as a single
dose of 1 g orally may be effective for early disease.
- Fluctuant nodes should be aspirated, not incised and
- Surgical excision of lymph nodes or extensive lymphedema can be
performed and may lead to significant functional and cosmetic
- Surgery should not be performed during active phases of the
disease, and when performed, should be preceded and followed by 2
weeks of antibiotic treatment.