STD Toolkit

Lymphogranuloma Venereum (LGV)

Symptoms:

  • Tender inguinal/femoral lymphadenopathy (usually unilateral)
  • Positive "groove" sign (the swollen lymph nodes are divided by the inguinal ligament)
  • Genital or rectal ulcer/papule
  • Proctocolitis (may include discharge, pain, constipation, fever, and tenesmus)
  • Colorectal fistulas and strictures

Definitive Diagnosis:

Positive culture or NAAT with genotyping that confirms serovars L1, L2, or L3. If testing is not available, a probable diagnosis may be made based on clinical suspicion, epidemiologic information, and the exclusion of other etiologies for proctocolitis, inguinal lymphadenopathy, or genital or rectal ulcers.

There are no guidelines for routine screening. LGV tests are not widely available; for those that have access to them, testing should be done when LGV is suspected.

  • PCR based genotyping - specimens can be rectal, cervical, or urethral swabs or urine
Recommended, with reservations:
  • Nucleic acid detection/NAAT - specimen is swab of lesion or bubo aspirate, rectal, cervical, or urethral swabs or urine. NAAT is the preferred testing method for rectal LGV.
  • Culture - specimen is swab of lesion or bubo aspirate. At best about 75-85% sensitivity.
  • Direct immunofluorescence - specimen is swab of lesion or bubo aspirate
  • Complement fixation titers - specimen is serum. May be supportive of diagnosis, but not diagnostic on its own. May need serial titers to determine infection.

First Line Treatment

Doxycycline 100mg #42

One tablet twice daily for 21 days

Alternative Treatment

Alternative:

Erythromycin base 500 mg orally four times daily for 21 days

Prolonged therapy may be required for HIV patients, and it may take longer for symptoms to resolve.

For more information on Lymphogranuloma venereum, see the CDC's Sexually Transmitted Diseases Treatment Guidelines, 2015.

Penile ulcer from LGV
Penile ulcer from LGV
Genital elephantiasis
Genital elephantiasis, caused by chronic LGV
Groove sign
Groove sign