II. Etiology

  1. Sexually Transmitted Disease
  2. Caused by Chlamydia trachomatis subtypes L1, L2, L3 in the United States

III. Epidemiology

  1. Previously rare in the United States
  2. Recent outbreaks in U.S.
    1. More common in HIV patients and homosexual men

IV. Symptoms

  1. General
    1. Fever and chills
    2. Headache or meningismus
    3. Anorexia
    4. Arthralgias and Myalgias
  2. Proctocolitis if rectal exposure
    1. Mucus or bloody discharge from anus
    2. Anal Pain
    3. Constipation
    4. Tenesmus

V. Signs

  1. Genital Lesion
    1. Appears 3 days to 3 weeks after exposure
    2. Starts as nontender Papule
    3. Develops small painless Vesicle or non-indurated Genital Ulcer at site within 3 to 30 days
  2. Rectal lesion or Proctitis
    1. Women and homosexual men
  3. Inguinal Syndrome
    1. Occurs 2-6 weeks after exposure
    2. Unilateral in 66% of cases
    3. Painful, tender inguinal or femoral Lymphadenopathy
      1. Inguinal Lymphadenopathy: Groove sign
        1. Large circular lymph nodes (buboes) above and below inguinal ligament
      2. May also involve rectal lymph nodes
    4. May progress to matted nodes and fistulas

VI. Differential Diagnosis

VII. Complications

  1. Perirectal Abscess
  2. Perianal Fistula or Stricture
  3. Secondary bacterial infection
  4. Lymphatic obstruction with secondary genital elephantiasis

VIII. Diagnosis: Options (choose one)

  1. Chlamydia trachomatis serotype L1, L2, L3 culture positive
    1. Bubo aspirate
    2. Rectal lesion culture
  2. Immunofluorescence showing Leukocytes with inclusion bodies
    1. Inguinal lymph node aspirate
  3. Microimmunofluorescence positive
    1. Lymphogranuloma venereum strain of Chlamydia trachomatis

X. Diagnosis

  1. Diagnosis is clinical
  2. Aspiration of bubo can be sent to lab (but not needed if presentation is classic)

XI. Differential Diagnosis

XII. Management

  1. Precautions
    1. Avoid incising buboes
  2. Preganancy or Lactation
    1. Erythromycin base 500 mg orally four times daily for 21 days
  3. Active infection
    1. Doxycycline 100 mg orally twice daily for 21 days (preferred)
    2. Erythromycin base 500 mg orally four times daily for 21 days
    3. Azithromycin 1 gram once weekly for 3 weeks
  4. Treat asymptomatic sexual contacts from last month
    1. Doxycycline 100 mg PO bid for 7 days or
    2. Azithromycin 1 gram PO x1 dose

Images: Related links to external sites (from Google)

Ontology: Lymphogranuloma Venereum (C0024286)

Definition (MSH) Subacute inflammation of the inguinal lymph glands caused by certain immunotypes of CHLAMYDIA TRACHOMATIS. It is a sexually transmitted disease in the U.S. but is more widespread in developing countries. It is distinguished from granuloma venereum (see GRANULOMA INGUINALE), which is caused by Calymmatobacterium granulomatis.
Definition (CSP) subacute inflammation of the inguinal lymph glands caused by certain immunotypes of Chlamydia trachomatis; a sexually transmitted disease in the United States but is more widespread in developing countries; do not confuse with granuloma venereum, which is caused by Calymmatobacterium granulomatis, for this use ENTEROBACTERIACEAE DISEASE.
Concepts Disease or Syndrome (T047)
MSH D008219
ICD9 099.1
ICD10 A55
SnomedCT 89427004, 186946009, 154391003, 266213004
English Lymphopathia venereum, Lymphogranuloma Inguinale, Lymphogranuloma Venereum, BUBO, CLIMATIC, DURAND-NICOLAS-FAVRE DISEASE, Durand-Nicolas-Favre disease, FAVRE-DURAND DISEASE, FREI DISEASE, LYMPHOGRANULOMA INGUINALE, LYMPHOGRANULOMA VENEREUM, LYMPHOPATHIA VENEREUM, PORADENITIS NOSTRAS, lymphogranuloma venereum, Climatic or tropical bubo, Nicolas-Favre disease, Chlamydial lymphogranuloma (venereum), LGV, E-214 LYMPHOGRANULOMA VENEREUM, Chlamydia trachomatis lymphadenitis, Lymphogranuloma Venereum [Disease/Finding], lymphogranuloma inguinale, disease freies, lgv, Lymphogranuloma venereum, Lymphogranuloma inguinale, LGV - Lymphogranuloma venereum, Nicholas Favre disease, Lymphogranuloma venereum (disorder), Favre-Nicolas, Frei, bubo; climactic, bubo; tropical, inguinal; lymphogranuloma, lymphogranuloma; chlamydial, lymphogranuloma; inguinale, lymphogranuloma; venereum, lymphopathia venereum, nicolas(-Durand)-Favre disease, poradenitis; nostras, Chlamydia; lymphadenitis, Chlamydia; lymphogranuloma, tropical; bubo, venereum; lymphogranuloma, Durand-Nicolas-Favre, Climatic AND/OR tropical bubo, Lymphogranuloma venereum (disorder) [Ambiguous], climatic; bubo
Dutch Chlamydia trachomatis lymfadenitis, lymphogranuloma inguinale, Chlamydia; lymfadenitis, Chlamydia; lymfogranuloom, bubo; climaticus, bubo; tropicus, inguinale; lymfogranuloom, lymfogranuloom; Chlamydia, lymfogranuloom; inguinale, lymfogranuloom; venereum, poradenitis; nostras, tropicus; bubo, venereum; lymfogranuloom, Lymphogranuloma (venereum) door Chlamydia, lymphogranuloma venereum, climaticus; bubo, Lymphogranuloma inguinale, Lymphogranuloma venereum
French LGV, Lymphadénite à Chlamydia trachomatis, Lymphogranulome inguinal, Maladie de Nicolas et Favre, Lymphogranulomatose inguinale subaigüe, LGV (LymphoGranulomatose Vénérienne), Lymphogranulomatose inguinale subaiguë, Lymphogranulomatose vénérienne, Lymphogranuloma venereum, Maladie de Nicolas-Favre
German Chlamydia trachomatis-Lymphadenitis, LGV, Lymphogranuloma inguinale (venereum) durch Chlamydien, Lymphgranulom venerisch, Lymphogranuloma inguinale, Lymphogranuloma venereum
Italian Linfoadenite da Chlamydia trachomatis, Linfogranuloma inguinale, Linfogranuloma venereo
Portuguese Linfadenite a Chlamydia trachomatis, Linfogranuloma inguinal, Linfogranuloma venéreo, Linfogranuloma Inguinal, Linfogranuloma Venéreo
Spanish Linfogranuloma inguinal, LGV, Linfadenitis por Chlamydia trachomatis, Lymphogranuloma venereum, LGV - Linfogranuloma venéreo, bubón climático Y/O tropical, bubón climático o tropical, enfermedad de Durand - Nicolas - Favre, enfermedad de Nicholas Favre, enfermedad de Nicolas - Favre, linfogranuloma inguinal, linfogranuloma venéreo (concepto no activo), linfogranuloma venéreo (trastorno), linfogranuloma venéreo, Linfogranuloma venéreo, Linfogranuloma Inguinal, Linfogranuloma Venéreo, Linfogranuloma Venereo
Japanese 性病性リンパ肉芽腫症, 鼡径リンパ肉芽腫, ソケイリンパニクゲシュ, セイビョウセイリンパニクガシュショウ, セイビョウセイリンパニクゲシュショウ, トラコーマクラミジア性リンパ節炎, ソケイリンパニクガシュ, トラコーマクラミジアセイリンパセツエン, ニコラ・ファブル病, リンパ肉芽腫-性病性, 性病性リンパ肉芽腫, 第4性病, 第四性病, 鼠径リンパ肉芽腫, 鼠径リンパ肉芽腫症, リンパ肉芽腫-鼠径
Swedish Lymphogranuloma venereum
Czech lymphogranuloma venereum, Lymphogranuloma venereum, Lymfadenitida vyvolaná Chlamydia trachomatis, Lymphogranuloma inguinale, LGV
Finnish Lymphogranuloma venereum
Korean 클라미디아 림프육아종(성병성)
Polish Choroba Nicolasa-Faure'a, Ziarnica weneryczna, Ziarnica pachwinowa, Ziarnica weneryczna pachwin, Choroba Duranda, Ziarniniak weneryczny
Hungarian lymphogranuloma inguinale, lymphogranuloma venereum, Chlamydia trachomatis lymphadenitis, LGV