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&lt;h1 class=&quot;text-4xl md:text-5xl font-semibold text-gray-900&quot;&gt;Lymphogranuloma venereum treatment guidelines&lt;/h1&gt;
&lt;div class=&quot;mt-4 text-gray-900 font-medium&quot;&gt;Also known as LGV&lt;/div&gt;
&lt;div class=&quot;w-full md:w-3/4 text-xl md:text-2xl prose mt-8 text-gray-700&quot;&gt;
&lt;p&gt;Lymphogranuloma venereum (LGV) is a genital infection caused by the less common serovars of&amp;nbsp;&lt;em&gt;Chlamydia trachomatis&lt;/em&gt;&amp;nbsp;(L1, L2, L3).&lt;/p&gt;
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&lt;div class=&quot;md:mr-2 lg:mr-4 xl:mr-12 -primary -glossary&quot;&gt;
&lt;div class=&quot;block-space&quot;&gt;
&lt;div class=&quot;prose&quot;&gt;
&lt;h2&gt;Causes&lt;/h2&gt;
&lt;/div&gt;
&lt;div class=&quot;block-space prose  &quot;&gt;
&lt;ul&gt;
&lt;li&gt;&lt;em&gt;Chlamydia trachomatis&amp;nbsp;&lt;/em&gt;serovars L1, L2, and L3.&lt;/li&gt;
&lt;li&gt;The L2 serovar has predominated among LGV cases in&amp;nbsp;&lt;abbr style=&quot;box-sizing: border-box; border-width: 0px 0px 1px; border-style: dotted; border-color: rgb(67 56 202 / var(--tw-border-opacity)); --tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; --tw-rotate: 0; --tw-skew-x: 0; --tw-skew-y: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgb(59 130 246 / 0.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000; --tw-shadow: 0 0 #0000; --tw-shadow-colored: 0 0 #0000; filter: initial !important; --tw-border-opacity: 1; --tw-text-opacity: 1; color: rgb(67 56 202 / var(--tw-text-opacity));&quot; data-tippy-content=&quot;&amp;lt;p&amp;gt;Men who have sex with men&amp;lt;/p&amp;gt;&quot;&gt;MSM&lt;/abbr&gt;.&lt;/li&gt;
&lt;li&gt;LGV is uncommon in developed countries, however, cases have increasingly occurred among&amp;nbsp;&lt;abbr style=&quot;box-sizing: border-box; border-width: 0px 0px 1px; border-style: dotted; border-color: rgb(67 56 202 / var(--tw-border-opacity)); --tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; --tw-rotate: 0; --tw-skew-x: 0; --tw-skew-y: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgb(59 130 246 / 0.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000; --tw-shadow: 0 0 #0000; --tw-shadow-colored: 0 0 #0000; filter: initial !important; --tw-border-opacity: 1; --tw-text-opacity: 1; color: rgb(67 56 202 / var(--tw-text-opacity));&quot; data-tippy-content=&quot;&amp;lt;p&amp;gt;Men who have sex with men&amp;lt;/p&amp;gt;&quot;&gt;MSM&lt;/abbr&gt;&amp;nbsp;where it mainly causes rectal infection.&lt;/li&gt;
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&lt;div class=&quot;prose&quot;&gt;
&lt;h2&gt;Clinical presentation&lt;/h2&gt;
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&lt;div class=&quot;block-space prose bg-gray-100  rounded block-padding&quot;&gt;
&lt;ul&gt;
&lt;li&gt;Can lead to proctitis with symptoms such as anorectal pain,&amp;nbsp;&lt;abbr style=&quot;box-sizing: border-box; border-width: 0px 0px 1px; border-style: dotted; border-color: rgb(67 56 202 / var(--tw-border-opacity)); --tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; --tw-rotate: 0; --tw-skew-x: 0; --tw-skew-y: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgb(59 130 246 / 0.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000; --tw-shadow: 0 0 #0000; --tw-shadow-colored: 0 0 #0000; filter: initial !important; --tw-border-opacity: 1; --tw-text-opacity: 1; color: rgb(67 56 202 / var(--tw-text-opacity));&quot; data-tippy-content=&quot;&amp;lt;p&amp;gt;Discharge is fluid which flows from a part of the body, such as the vagina or anus.&amp;lt;/p&amp;gt;&quot;&gt;discharge&lt;/abbr&gt;, tenesmus, bleeding and constipation. In some cases, this can be severe and&amp;nbsp;&lt;abbr style=&quot;box-sizing: border-box; border-width: 0px 0px 1px; border-style: dotted; border-color: rgb(67 56 202 / var(--tw-border-opacity)); --tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; --tw-rotate: 0; --tw-skew-x: 0; --tw-skew-y: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgb(59 130 246 / 0.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000; --tw-shadow: 0 0 #0000; --tw-shadow-colored: 0 0 #0000; filter: initial !important; --tw-border-opacity: 1; --tw-text-opacity: 1; color: rgb(67 56 202 / var(--tw-text-opacity));&quot; data-tippy-content=&quot;&amp;lt;p&amp;gt;Chronic means a health condition or disease that is persistent or has long-lasting effects. The term chronic is often used when the disease lasts for more than three months.&amp;lt;/p&amp;gt;&quot;&gt;chronic&lt;/abbr&gt;, mimicking inflammatory bowel disease.&lt;/li&gt;
&lt;li&gt;Asymptomatic cases of rectal LGV can also occur.&lt;/li&gt;
&lt;li&gt;Less commonly, LGV can also cause genital ulceration with inguinal bubo (abscess) formation.&lt;/li&gt;
&lt;li&gt;&lt;abbr style=&quot;box-sizing: border-box; border-width: 0px 0px 1px; border-style: dotted; border-color: rgb(67 56 202 / var(--tw-border-opacity)); --tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; --tw-rotate: 0; --tw-skew-x: 0; --tw-skew-y: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgb(59 130 246 / 0.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000; --tw-shadow: 0 0 #0000; --tw-shadow-colored: 0 0 #0000; filter: initial !important; --tw-border-opacity: 1; --tw-text-opacity: 1; color: rgb(67 56 202 / var(--tw-text-opacity));&quot; data-tippy-content=&quot;&amp;lt;p&amp;gt;Men who have sex with men&amp;lt;/p&amp;gt;&quot;&gt;MSM&lt;/abbr&gt;&amp;nbsp;who have a positive anal chlamydia test should be assessed for symptoms of proctitis. Refer to&amp;nbsp;&lt;a href=&quot;https://www.mshc.org.au/health-professionals/treatment-guidelines/proctitis-treatment-guidelines&quot;&gt;proctitis treatment guidelines&lt;/a&gt;.&lt;/li&gt;
&lt;li&gt;&lt;abbr style=&quot;box-sizing: border-box; border-width: 0px 0px 1px; border-style: dotted; border-color: rgb(67 56 202 / var(--tw-border-opacity)); --tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; --tw-rotate: 0; --tw-skew-x: 0; --tw-skew-y: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgb(59 130 246 / 0.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000; --tw-shadow: 0 0 #0000; --tw-shadow-colored: 0 0 #0000; filter: initial !important; --tw-border-opacity: 1; --tw-text-opacity: 1; color: rgb(67 56 202 / var(--tw-text-opacity));&quot; data-tippy-content=&quot;&amp;lt;p&amp;gt;Men who have sex with men&amp;lt;/p&amp;gt;&quot;&gt;MSM&lt;/abbr&gt;&amp;nbsp;who present with symptoms of proctitis should be tested for chlamydia, gonorrhoea, syphilis and herpes&amp;nbsp;using an anal swab.&lt;/li&gt;
&lt;li&gt;Men who are asymptomatic contacts of LGV should be screened for chlamydia with urine and an anal swab.&lt;/li&gt;
&lt;/ul&gt;
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&lt;div class=&quot;h-full w-full flex items-center justify-center&quot;&gt;&lt;img src=&quot;https://mshc.imgix.net/images/general/Clinical_images/Penile_acute_LGV_ulcer.png?auto=format&amp;amp;w=800&amp;amp;fit=clip&quot; class=&quot;rounded&quot; /&gt;&lt;/div&gt;
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&lt;div class=&quot;h-full w-full flex items-center justify-center&quot;&gt;&lt;img src=&quot;https://mshc.imgix.net/images/general/Clinical_images/LGV_ulcer.png?auto=format&amp;amp;w=800&amp;amp;fit=clip&quot; class=&quot;rounded&quot; /&gt;&lt;/div&gt;
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&lt;div class=&quot;h-full w-full flex items-center justify-center&quot;&gt;&lt;img src=&quot;https://mshc.imgix.net/images/general/Clinical_images/Penile_acute_LGV_ulcer.png?auto=format&amp;amp;w=800&amp;amp;fit=clip&quot; class=&quot;rounded&quot; /&gt;&lt;/div&gt;
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&lt;div class=&quot;caption  text-sm text-white bg-gray-800 p-2 w-full flex&quot;&gt;&lt;span class=&quot;opacity-70 w-12 text-center&quot;&gt;1/2&lt;/span&gt;LGV ulcer&lt;/div&gt;
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&lt;p&gt;&lt;strong&gt;Warning&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;May contain graphic images of human anatomy, medical conditions&amp;nbsp;and medical procedures. Viewing&amp;nbsp;discretion is advised.&lt;/p&gt;
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&lt;p&gt;LGV ulcers&lt;/p&gt;
&lt;/div&gt;
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&lt;div class=&quot;prose&quot;&gt;
&lt;h2&gt;Diagnosis&lt;/h2&gt;
&lt;/div&gt;
&lt;div class=&quot;block-space prose  &quot;&gt;
&lt;table class=&quot;table&quot; border=&quot;1&quot;&gt;
&lt;thead&gt;
&lt;tr&gt;
&lt;th scope=&quot;col&quot;&gt;Test&lt;/th&gt;
&lt;th scope=&quot;col&quot;&gt;Site/ Specimen&lt;/th&gt;
&lt;th scope=&quot;col&quot;&gt;Comments&lt;/th&gt;
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&lt;tbody&gt;
&lt;tr&gt;
&lt;td&gt;NAAT&lt;/td&gt;
&lt;td&gt;
&lt;p&gt;Swab&lt;/p&gt;
&lt;p&gt;Aspirated fluid from inguinal buboes&lt;/p&gt;
&lt;/td&gt;
&lt;td&gt;The LGV serovars can specifically be identified through genotyping of the chlamydia positive sample; however, not all laboratories are able to perform genotyping.&lt;/td&gt;
&lt;/tr&gt;
&lt;tr&gt;
&lt;td&gt;Serology for&amp;nbsp;&lt;em&gt;C. trachomatis&lt;/em&gt;&lt;/td&gt;
&lt;td&gt;Blood&lt;/td&gt;
&lt;td&gt;
&lt;p&gt;Can sometimes assist in the diagnosis of LGV, such as when the rectal swab is negative or if it is not possible to amplify the omp1 gene.&amp;nbsp;&lt;/p&gt;
&lt;p&gt;High antibody titres are often found with LGV, which is not usually the case with uncomplicated genital chlamydial infection.&lt;/p&gt;
&lt;p&gt;Serology does not, however, distinguish between LGV and non-LGV serovars.&lt;/p&gt;
&lt;/td&gt;
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&lt;div class=&quot;prose&quot;&gt;
&lt;h2&gt;Management&lt;/h2&gt;
&lt;/div&gt;
&lt;div class=&quot;block-space prose  &quot;&gt;
&lt;h3&gt;Index patient&lt;/h3&gt;
&lt;table class=&quot;table&quot; border=&quot;1&quot;&gt;
&lt;thead&gt;
&lt;tr&gt;
&lt;th scope=&quot;col&quot;&gt;Condition&lt;/th&gt;
&lt;th scope=&quot;col&quot;&gt;Recommended&lt;/th&gt;
&lt;th scope=&quot;col&quot;&gt;Extra comments&lt;/th&gt;
&lt;/tr&gt;
&lt;/thead&gt;
&lt;tbody&gt;
&lt;tr&gt;
&lt;td&gt;LGV&lt;/td&gt;
&lt;td&gt;
&lt;p&gt;&lt;strong&gt;Doxycycline 100mg PO, twice daily for 21 days&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;OR&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Azithromycin 1g PO, once per week for 3 doses.&lt;/strong&gt;&lt;/p&gt;
&lt;/td&gt;
&lt;td&gt;
&lt;p&gt;Doxycycline is preferred over azithromycin as clinical data are lacking for azithromycin.&lt;/p&gt;
&lt;p&gt;&lt;abbr style=&quot;box-sizing: border-box; border-width: 0px 0px 1px; border-style: dotted; border-color: rgb(67 56 202 / var(--tw-border-opacity)); --tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; --tw-rotate: 0; --tw-skew-x: 0; --tw-skew-y: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgb(59 130 246 / 0.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000; --tw-shadow: 0 0 #0000; --tw-shadow-colored: 0 0 #0000; filter: initial !important; --tw-border-opacity: 1; --tw-text-opacity: 1; color: rgb(67 56 202 / var(--tw-text-opacity));&quot; data-tippy-content=&quot;&amp;lt;p&amp;gt;Men who have sex with men&amp;lt;/p&amp;gt;&quot;&gt;MSM&lt;/abbr&gt;&amp;nbsp;who present with symptomatic proctitis that is positive for rectal&amp;nbsp;&lt;em&gt;C. trachomatis&lt;/em&gt;&amp;nbsp;should be treated presumptively for LGV, irrespective of the LGV genotype result which may not be available for several weeks.&lt;/p&gt;
&lt;p&gt;Sometimes LGV can be more severe. In these cases, more prolonged treatment or treatment with alternative antibiotics may be required. This should be discussed with a senior clinician.&amp;nbsp;&lt;/p&gt;
&lt;/td&gt;
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&lt;div class=&quot;prose&quot;&gt;
&lt;h2&gt;Contact tracing &amp;amp; partner management&lt;/h2&gt;
&lt;/div&gt;
&lt;div class=&quot;block-space prose  &quot;&gt;
&lt;p&gt;Contact tracing for LGV should be initiated.&lt;/p&gt;
&lt;p&gt;All asymptomatic sexual partners of men with LGV should be screened for LGV and offered treatment with&amp;nbsp;&lt;strong&gt;Doxycycline 100mg orally twice daily for 21 days.&lt;/strong&gt;&lt;/p&gt;
&lt;/div&gt;
&lt;/div&gt;
&lt;/div&gt;
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&lt;/div&gt;
&lt;/div&gt;
&lt;/header&gt;

&lt;div class=&quot;md:flex container&quot;&gt;
&lt;div class=&quot;md:w-1/3&quot; role=&quot;complementary&quot;&gt;
&lt;div class=&quot;md:ml-2 lg:ml-4 xl:ml-12 -sidebar&quot;&gt;
&lt;div class=&quot;block-space prose&quot;&gt;
&lt;div class=&quot;space-y-2&quot;&gt;
&lt;h2 class=&quot;block-title&quot;&gt;&lt;strong&gt;Related treatment guidelines&lt;/strong&gt;&lt;/h2&gt;
&lt;div&gt;&lt;a href=&quot;https://www.mshc.org.au/health-professionals/treatment-guidelines/chlamydia-treatment-guidelines&quot;&gt;Chlamydia treatment guidelines&lt;/a&gt;&lt;/div&gt;
&lt;div&gt;&lt;a href=&quot;https://www.mshc.org.au/health-professionals/treatment-guidelines/enteric-infections-in-msm-treatment-guidelines&quot;&gt;Enteric infections in MSM treatment guidelines&lt;/a&gt;&lt;/div&gt;
&lt;div&gt;&lt;a href=&quot;https://www.mshc.org.au/health-professionals/treatment-guidelines/gonorrhoea-treatment-guidelines&quot;&gt;Gonorrhoea treatment guidelines&lt;/a&gt;&lt;/div&gt;
&lt;div&gt;&lt;a href=&quot;https://www.mshc.org.au/health-professionals/treatment-guidelines/herpes-treatment-guidelines&quot;&gt;Herpes treatment guidelines&lt;/a&gt;&lt;/div&gt;
&lt;div&gt;&lt;a href=&quot;https://www.mshc.org.au/health-professionals/treatment-guidelines/lgv-in-msm-treatment-guidelines&quot;&gt;Lymphogranuloma venereum treatment guidelines&lt;/a&gt;&lt;/div&gt;
&lt;div&gt;&lt;a href=&quot;https://www.mshc.org.au/health-professionals/treatment-guidelines/mycoplasma-genitalium-treatment-guidelines&quot;&gt;Mycoplasma genitalium treatment guidelines&lt;/a&gt;&lt;/div&gt;
&lt;/div&gt;
&lt;/div&gt;
&lt;/div&gt;
&lt;/div&gt;
&lt;/div&gt;
&lt;div class=&quot;bg-gray-100 py-6&quot;&gt;
&lt;div class=&quot;container text-left flex justify-between items-center text-xs&quot; role=&quot;contentinfo&quot; aria-label=&quot;Page last reviewed and back to top link&quot;&gt;
&lt;div&gt;Page last reviewed on&amp;nbsp;&lt;span class=&quot;font-semibold block sm:inline-block&quot;&gt;21 July 2021&lt;/span&gt;&lt;/div&gt;
&lt;/div&gt;
&lt;/div&gt;

SEXUAL HEALTH MATTERS

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Lymphogranuloma venereum LGV treatment guidelines