From the Guidelines
Lymphogranuloma Venereum (LGV) is caused by specific invasive serovars (L1, L2, or L3) of Chlamydia trachomatis and can be diagnosed by swabbing the ulcer or through urine PCR testing, though additional genotyping is required for definitive diagnosis. The diagnosis of LGV is typically made by testing for the presence of C. trachomatis, and then confirming the specific serovar through genotyping 1. According to the 2018 guidelines, LGV can be diagnosed by cell culture, serology, or nucleic acid amplification test (NAAT) on a swab of the ulcer base, bubo drainage, or rectum 1.
Key Points
- LGV is caused by specific invasive serovars of Chlamydia trachomatis
- Diagnosis can be made by swabbing the ulcer or through urine PCR testing
- Additional genotyping is required for definitive diagnosis
- Testing sexual partners is essential as they may be asymptomatically infected
- Patients should abstain from sexual activity until treatment is completed
The recommended treatment for LGV is doxycycline 100mg twice daily for 21 days, which is longer than the standard 7-day regimen for non-LGV chlamydial infections. Alternative treatments include erythromycin 500mg four times daily for 21 days if doxycycline is contraindicated. LGV typically presents in three stages: a primary stage with a painless papule or ulcer, a secondary stage with painful lymphadenopathy (buboes), and a tertiary stage with potential complications like genital elephantiasis or rectal strictures.
Diagnosis and Treatment
- Diagnosis: cell culture, serology, or NAAT on a swab of the ulcer base, bubo drainage, or rectum
- Treatment: doxycycline 100mg twice daily for 21 days or erythromycin 500mg four times daily for 21 days
- Testing sexual partners is essential to prevent further transmission 1.
It's worth noting that while the 1998 guidelines provide some information on the diagnosis and treatment of LGV, the 2018 guidelines provide more up-to-date and comprehensive information on the diagnosis and treatment of LGV 1.
From the Research
Causes of Lymphogranuloma Venereum (LGV)
- LGV is caused by Chlamydia trachomatis, specifically serovars L1, L2, and L3 2, 3, 4, 5, 6
- These serovars are distinct from other Chlamydia trachomatis serovars that cause different infections 2, 4
Diagnosis of LGV
- Diagnosis of LGV can be challenging and relies on laboratory testing, including nucleic acid amplification testing of direct specimens 3
- Rectal swabs can be used to detect Chlamydia trachomatis DNA using polymerase chain reaction (PCR) techniques 2, 4, 5
- Urine PCR testing may not be the primary method for diagnosing LGV, as the infection is typically detected in rectal swabs or other direct specimens 2, 4, 5
- High-resolution melting analysis (HRMA) and multiplex allele-specific PCR can also be used to differentiate LGV-related serovars from other Chlamydia trachomatis serovars 4
Clinical Presentation and Treatment
- LGV can present as a painless ulcerated papule on the genitalia or distal proctitis, and can progress to major complications if left untreated 3, 5
- Treatment typically involves doxycycline administered for three weeks, and it is essential to suspect and diagnose LGV early to avoid major complications 3, 5, 6