Presentation
Clinicians should include lymphogranuloma venereum (LGV) as part of the differential diagnosis of genital ulcer disease, inguinal lymphadenopathy, or proctocolitis, especially in men who have sex with men.
Diagnosis
Clinicians should diagnose LGV through the presence of consistent clinical findings, such as inguinal lymphadenopathy and erosive proctocolitis, as well as the absence of other definable pathologies.
Treatment
Doxycycline (100 mg orally [PO] twice daily [bid]) for 21 days is the preferred treatment regimen for LGV.
Treatment should not await LGV serovar determination, even in the context of clinicians electing to investigate LGV-specific genotyping.
Management of Partners
Clinicians should consider both the human immunodeficiency virus (HIV) exposure and the sexually transmitted infection (STI) exposure to partners when HIV-infected patients present with a new STI. Clinicians should also assess for the presence of other STIs.
Management of HIV Exposure
When HIV-infected patients present with a new STI, clinicians should encourage their partner(s) to undergo HIV testing at baseline, 1, 3, and 6 months. In New York State, if the test result is positive, a Western blot assay must be performed to confirm diagnosis of HIV infection.
Clinicians should be vigilant for any post-exposure acute febrile illness accompanied by rash, lymphadenopathy, myalgias, and/or sore throat. If the partner presents with signs or symptoms of acute HIV seroconversion, a quantitative ribonucleic acid polymerase chain reaction (RNA PCR) should be obtained, and consultation with an HIV Specialist should be sought. Positive RNA tests should be confirmed with HIV antibody testing performed within 6 weeks of the RNA test.
Clinicians should offer assistance with partner notification if needed.
Management of LGV Exposure
Clinicians should encourage partners of patients with LGV whose exposure occurred within 60 days prior to symptom onset to be examined and treated with a full 21-day course of doxycycline.
