Sexually Transmitted Infections: Lymphogranuloma Venereum

Published on 06/06/2015 by admin

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Last modified 06/06/2015

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Chapter 53 Sexually Transmitted Infections: Lymphogranuloma Venereum

INTRODUCTION

Description: Lymphogranuloma venereum (LVG) is a potentially destructive infection caused by one of a number of serotypes (L-1, L-2, L-3) of Chlamydia trachomatis. Although uncommon in the United States, this infection causes significant morbidity.
Prevalence: Uncommon (600 cases per year in the United States).
Predominant Age: Younger reproductive.
Genetics: LVG is 20 times more common in men than in women.

ETIOLOGY AND PATHOGENESIS

Causes: LGV is caused by several serotypes of Chlamydia trachomatis.
Risk Factors: Sexual trauma and exposure to the infective agent.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Painless vesicle that heals quickly leaving no scar, generally located on posterior aspect of vulva or vestibule
• Proctitis, tenesmus, or bloody rectal discharge in anorectal infections (anal intercourse)
• Progressive adenopathy with bubo formation (groove sign—the “groove sign” is not specific to LGV; it may also be seen in other inflammatory processes such as acne inversa)
• Severe fibrosis and scarring (elephantiasis, “esthiomene”; rectal stenosis may occur)

DIAGNOSTIC APPROACH

Differential Diagnosis

• Granuloma inguinale
• Chancroid
• Herpes simplex
• Syphilis
• Cancer (vulvar or colon)

Associated Conditions: Other sexually transmitted infections, human immunodeficiency virus (HIV), dyspareunia, rectal stricture or stenosis.

Workup and Evaluation

Laboratory: Complement fixation test (a titer of greater than 1 : 64 is highly suspicious for LGV). Approximately 20% of patients with LGV will have false-positive Venereal Disease Research Laboratory (VDRL) test results.
Imaging: No imaging indicated.
Special Tests: None indicated. (Biopsy of the lesions is not diagnostic because of the nonspecific damage present. Enlarged lymph nodes should not be biopsied or opened: chronic sinuses will result.)
Diagnostic Procedures:

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