title: Approach to lymphogranuloma venereum.
abstract: OBJECTIVE
  To review the literature about lymphogranuloma venereum (LGV) and to provide an overview and discussion of practice guidelines.
  
  
  METHODS
  The terms Chlamydia trachomatis and lymphogranuloma venereum were searched separately in PubMed. Empirical studies, practice reviews, and clinical guidelines were included. All reference lists were reviewed for additional articles.
  
  
  RESULTS
  Since 2003, there has been a resurgence of LGV among men who have sex with men in many Western countries, including Canada. Although LGV is a serovar of Chlamydia trachomatis (serovar L), it can invade regional lymph nodes, and consequently presents with different symptoms than the other subtypes of chlamydia (serovars A through K). Specifically, LGV transitions through 3 phases: a painless papule or ulcer at the site of inoculation; invasion of the regional lymph nodes, which can present with an inguinal or rectal syndrome; and irreversible destruction of lymph tissue. In contrast, chlamydia serovars A to K exclusively produce superficial mucosal infections. Lymphogranuloma venereum also requires a different treatment regimen than other chlamydia serovars.
  
  
  CONCLUSIONS
  In light of the current resurgence of LGV, its unique symptoms and clinical course, and its requirement for a different treatment than other chlamydia serovars, it is important for primary care providers to recognize when LGV should be included as an appropriate differential diagnosis.
authors.affiliation: Associate Professor of Nursing at the University of Ottawa in Ontario. pjobyrne@uottawa.ca.
authors.forename: Patrick
authors.initials: P
authors.lastname: O'Byrne
authors.affiliation: Associate Professor of Medicine at the University of Ottawa.
authors.forename: Paul
authors.initials: P
authors.lastname: MacPherson
authors.affiliation: Family physician and Lecturer of Medicine at the University of Ottawa.
authors.forename: Stephane
authors.initials: S
authors.lastname: DeLaplante
authors.affiliation: Medical Director of the Ottawa Public Health Sexual Health Centre.
authors.forename: Gila
authors.initials: G
authors.lastname: Metz
authors.affiliation: Nurse practitioner at the Ottawa Public Health Sexual Health Centre.
authors.forename: Andree
authors.initials: A
authors.lastname: Bourgault
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002692:Chlamydia trachomatis / Q000145:classification; D004318:Doxycycline / Q000627:therapeutic use*; D006801:Humans; D008219:Lymphogranuloma Venereum / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D017410:Practice Guidelines as Topic
chemical_list: D000900:Anti-Bacterial Agents; D004318:Doxycycline