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CC2B Correct Diagnosis of Lymphogranuloma Venereum Makes All the Difference

Thursday, September 22, 2016: 7:20 AM
Salon E
Deborah Richmond, NP-C1, Lawrence R Crane, MD FACP FIDSA1, James B. Kent, MS2, Paul Lephart, PhD, D(ABMM)3, Elizabeth A Secord, MD4, Hossein Salimnia, Ph.D., D(ABMM)5 and Jonathan Allen Cohn, MD MS FACP FIDSA1, 1Wayne State University Tolan Park Medical Building, Wayne State University, Detroit, MI, 2Epidemiology / HIV-Body Art-Viral Hepatitis-STD, Michigan Department of Health and Human Services, Lansing, MI, 3Detroit Medical Center University Laboratories, Detroit Medical Center, Detroit, MI, 4Children's Hospital of Michigan, Wayne State University, Detroit, MI, 5Detroit Medical Center University Laboratories, Wayne State University, Detroit, MI

     
Introduction: 

Lymphogranuloma venereum (LGV) is a Sexually Transmitted Disease (STD) that is caused by Chlamydia  trachomatis serovars L1, L2 or L3.

As patients presented with symptoms of genital ulcer, unilateral painful inguinal lymph node swelling, or proctitis with rectal discharge, tenesmus and constipation, we began to investigate the possibility of the diagnosis of LGV.  A swab of the penile lesion or anal canal tested positive for C. trachomatis by standard nucleic acid amplification (NAAT). LGV was confirmed by specific PCR testing at Centers for Disease Control (not FDA approved for clinical care). Probable cases did not have LGV specific PCR testing available.

Case Description: 

We describe 27 cases (18 confirmed and 9 probable) of LGV between July 2015 and April 2016 in our Infectious Disease and STD clinics. All of the cases were HIV infected; 2 were newly diagnosed at the time of LGV diagnosis. Some of the patients were found to be co-infected with other STDs as well as Hepatitis C.

Five patients presented with non-resolving penile ulcer of whom 2 had unilateral adenopathy. All were positive for C. trachomatis by NAAT; two ulcers were confirmed as LGV by specific PCR.

There were 22 cases of LGV associated proctitis: most were symptomatic and all were C. trachomatis positive.  Sixteen were confirmed as LGV positive.  Five cases with proctitis presented to emergency rooms or consultants. They had abdominal/ pelvic CT scans and/or colonoscopy with biopsy prior to Chlamydia/LGV testing, accurate diagnosis and treatment.

All cases had resolution of symptoms with doxycycline 100 mg BID for 21 days per CDC Treatment Guidelines 2015.

Discussion:  

Careful clinical assessment along with collaboration with the State Health Department and the CDC is necessary to achieve accurate diagnosis, treatment, partner follow-up and prevention of further patient morbidity.

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