What are the concerns with treating lymphogranuloma venereum (LGV) in pregnancy?

Treatment of Lymphogranuloma Venereum in Pregnancy

Pregnant women with lymphogranuloma venereum (LGV) should be treated with erythromycin base 500 mg orally four times a day for 21 days, as doxycycline is contraindicated during pregnancy. 1, 2

Treatment Recommendations

• The standard treatment for LGV is doxycycline 100 mg orally twice daily for 21 days, but this is contraindicated during pregnancy 2
• Erythromycin base 500 mg orally four times a day for 21 days is the recommended alternative regimen for pregnant and lactating women 1
• Sulfisoxazole (500 mg orally four times a day for 21 days) was historically listed as an alternative treatment option, but pregnancy is a relative contraindication to the use of sulfonamides 1
• Azithromycin may have activity against C. trachomatis and could potentially be effective in multiple doses over 2-3 weeks, but clinical data regarding its use for LGV in pregnancy are lacking 1, 3

Monitoring and Follow-Up

• Patients should be followed clinically until all signs and symptoms have completely resolved 1, 2
• Treatment cures the infection and prevents ongoing tissue damage, although tissue reaction can result in scarring 1
• Buboes may require aspiration through intact skin or incision and drainage to prevent the formation of inguinal/femoral ulcerations 1
• If left untreated, LGV can cause irreversible late sequelae, making prompt and appropriate treatment essential 3, 4

Management of Sex Partners

• Sexual partners who had contact with the patient during the 30 days preceding the onset of symptoms should be:
  • Examined for signs of infection 1, 2
  • Tested for urethral or cervical chlamydial infection 1, 2
  • Treated appropriately if infected 1, 2

Special Considerations

• Pregnant women with LGV may be at risk for complications if not treated appropriately, as the infection can cause tissue damage 3
• The 21-day course of erythromycin is necessary to ensure complete eradication of the infection 2, 5
• There is limited research specifically addressing LGV treatment outcomes in pregnant women, but the erythromycin regimen has been the consistently recommended approach across multiple CDC guidelines 1

Common Pitfalls to Avoid

• Inadequate duration of therapy (full 21-day course is required) 2, 5
• Failure to follow up until complete resolution of symptoms 1, 2
• Inadequate management of sex partners, which could lead to reinfection 1, 2
• Delayed diagnosis and treatment, which may lead to more severe disease and complications 3, 4