Pitfalls in the diagnosis and management of inguinal lymphogranuloma venereum: important lessons from a case series.
Current lymphogranuloma venereum (LGV) guidelines mainly focus on anorectal infections. Inguinal LGV infections have been rare in the current epidemic among men who have sex with men (MSM), but might require a different approach not yet recommended in current guidelines for the treatment and diagnosis of LGV. We describe 4 inguinal LGV cases. Three MSM developed inguinal LGV infection several weeks after a previous consultation, of which two had received azithromycin after being notified for LGV. Three failed the recommended 21 days doxycycline treatment. These inguinal LGV cases highlight 3 pitfalls in the current standard management of LGV: (1) Urethral chlamydia infections in MSM can be caused by LGV biovars that in contrast to non-LGV biovars require prolonged antibiotic therapy. (2) The recommended one gram azithromycin contact treatment seems insufficient to prevent established infections. (3) Inguinal LGV may require prolonged courses of doxycycline, exceeding the currently advised 21 days regimen.
Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Emerentiana Veronica
EV
Oud
Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
Nynke Hesselina Neeltje
NH
de Vrieze
General Practitioners Office Heijnen & de Meij, Amsterdam, The Netherlands.
Arjan
A
de Meij
Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands The Netherlands STI Outpatient Clinic, Public Health Service Amsterdam, Amsterdam, The Netherlands Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Henry John C
HJ
de Vries
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D002690:Chlamydia Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D004318:Doxycycline / Q000627:therapeutic use*; D015658:HIV Infections / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D018451:Homosexuality, Male; D006801:Humans; D007264:Inguinal Canal; D008219:Lymphogranuloma Venereum / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017211:Treatment Failure; D014522:Urethral Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*
D000900:Anti-Bacterial Agents; D017963:Azithromycin; D004318:Doxycycline
Human immunodeficiency virus; Lymphogranuloma venereum; Men who have sex with men; Sexually transmitted infection