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&lt;h1 id=&quot;content&quot;&gt;&lt;strong&gt;LGV (Lymphogranuloma Venereum) Treatment in Thailand&lt;/strong&gt;&lt;/h1&gt;
&lt;p&gt;Lymphogranuloma venereum (LGV) is caused by&amp;nbsp;&lt;em&gt;C. trachomatis&lt;/em&gt;&amp;nbsp;serovars L1, L2, or L3&amp;nbsp;&lt;em&gt;&lt;a href=&quot;https://www.cdc.gov/std/tg2015/references.htm#386&quot;&gt;(386,387)&lt;/a&gt;&lt;/em&gt;. The most common clinical manifestation of LGV among heterosexuals is tender inguinal and/or femoral lymphadenopathy that is typically unilateral. A self-limited genital ulcer or papule sometimes occurs at the site of inoculation. However, by the time patients seek care, the lesions have often disappeared. Rectal exposure in women or MSM can result in proctocolitis mimicking inflammatory bowel disease, and clinical findings may include mucoid and/or hemorrhagic rectal discharge, anal pain, constipation, fever, and/or tenesmus&amp;nbsp;&lt;em&gt;&lt;a href=&quot;https://www.cdc.gov/std/tg2015/references.htm#388&quot;&gt;(388,389)&lt;/a&gt;&lt;/em&gt;. Outbreaks of LGV protocolitis have been reported among MSM&amp;nbsp;&lt;em&gt;&lt;a href=&quot;https://www.cdc.gov/std/tg2015/references.htm#390&quot;&gt;(390-392)&lt;/a&gt;&lt;/em&gt;. LGV can be an invasive, systemic infection, and if it is not treated early, LGV proctocolitis can lead to chronic colorectal fistulas and strictures; reactive arthropathy has also been reported. However, reports indicate that rectal LGV can be asymptomatic&amp;nbsp;&lt;em&gt;&lt;a href=&quot;https://www.cdc.gov/std/tg2015/references.htm#393&quot;&gt;(393)&lt;/a&gt;&lt;/em&gt;. Persons with genital and colorectal LGV lesions can also develop secondary bacterial infection or can be coinfected with other sexually and nonsexually transmitted pathogens.&lt;/p&gt;
&lt;div class=&quot;para&quot;&gt;
&lt;p&gt;LGV is caused by serotypes L1, L2, and L3 of the bacteria&amp;nbsp;&lt;em&gt;Chlamydia trachomatis&lt;/em&gt;. These serotypes differ from the chlamydial serotypes that cause&amp;nbsp;trachoma, inclusion conjunctivitis, and&amp;nbsp;&lt;a href=&quot;https://www.msdmanuals.com/professional/infectious-diseases/sexually-transmitted-diseases-stds/chlamydial-mycoplasmal-and-ureaplasmal-mucosal-infections&quot; data-preview-itemid=&quot;c1eb73ae00a643b69b7170e6abaa7660&quot;&gt;chlamydial urethritis and cervicitis&lt;/a&gt;&amp;nbsp;because they can invade and reproduce in regional lymph nodes.&lt;/p&gt;
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&lt;div class=&quot;para&quot;&gt;
&lt;p&gt;LGV occurs sporadically in the US but is endemic in parts of Africa, India, Southeast Asia, South America, and the Caribbean. It is diagnosed much more often in men than women. LGV is being increasingly reported in North America, Europe, and Australia among men who have sex with men (MSM).&lt;/p&gt;
&lt;h3&gt;&lt;strong&gt;Transmission&lt;/strong&gt;&lt;/h3&gt;
&lt;p&gt;LGV is almost exclusively transmitted sexually. The bacteria enter through a moist mucosal surface &amp;ndash; most commonly, the rectum or vagina, but infections in the penis or mouth are also possible. Like all sexually transmitted infections, anyone who has vaginal, anal and/or oral sex without using a condom can acquire LGV.&lt;/p&gt;
&lt;p&gt;The activity with the highest risk of LGV transmission is unprotected anal intercourse. Fisting, sharing of sex toys and rectal douching can also lead to LGV transmission.&lt;/p&gt;
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&lt;h2 id=&quot;SymptomsAndSigns&quot; class=&quot;topic__header--section&quot;&gt;&lt;strong&gt;Symptoms and Signs&lt;/strong&gt;&lt;/h2&gt;
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&lt;p&gt;Lymphogranuloma venereum occurs in 3 stages.&lt;/p&gt;
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&lt;p&gt;The&amp;nbsp;&lt;strong&gt;1st stage&lt;/strong&gt;&amp;nbsp;begins after an incubation period of about 3 days with a small skin lesion at the site of entry. It may cause the overlying skin to break down (ulcerate) but heals so quickly that it may pass unnoticed.&amp;nbsp;Symptoms usually develop between three days and three weeks after exposure. A small, painless blister or sore appears where the infection first entered the body. This may go unnoticed. There can be small groups of these, which look a little like herpes infection. There may also be blisters on other parts of the body, such as around the anus, or on the lip or in the mouth, as well as systemic symptoms such as fever and tiredness. A tender spot can develop in the lymph glands in the groin. Men may experience proctitis, an inflammation of the lining of the rectum (the rectal mucosa). Other symptoms include rectal pain, discharge, bloody stools, constipation and tenesmus (the feeling of needing to empty the bowels). However, many people may have no symptoms at this stage. This is particularly true for women.&lt;/p&gt;
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&lt;p&gt;The&amp;nbsp;&lt;strong&gt;2nd stage&lt;/strong&gt;&amp;nbsp;usually begins in men after about 2 to 4 weeks after exposure, with the inguinal lymph nodes on one or both sides enlarging and forming large, tender, sometimes fluctuant masses &lt;span style=&quot;color: #ff6600;&quot;&gt;(buboes)&amp;nbsp;&lt;/span&gt;inflamed and swollen lymph glands may appear in the groin, armpit or neck. Anal infection can cause painful ulcerations, discharge and bleeding. You may have a fever or rash.. The buboes stick to deeper tissues and cause the overlying skin to become inflamed, sometimes with fever and malaise. In women, backache or pelvic pain is common; the initial lesions may be on the cervix or upper vagina, resulting in enlargement and inflammation of deeper perirectal and pelvic lymph nodes. Multiple draining sinus tracts may develop and discharge pus or blood.&amp;nbsp;&lt;/p&gt;
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&lt;p&gt;In the&amp;nbsp;&lt;strong&gt;3rd stage,&lt;/strong&gt;&amp;nbsp;lesions heal with scarring, but sinus tracts can persist or recur. Persistent inflammation due to untreated infection obstructs the lymphatic vessels, causing swelling and skin sores. Most people recover after the second stage of LGV if they get appropriate treatment. If left untreated, the symptoms can become more severe, causing general swelling of the lymph glands, extreme swelling of the genitals, with ulcers, and damage inside the rectum or vagina, causing lasting damage to infected tissue and general health. Scarring, swelling and deformity in infected areas has also been reported. Spread of the bacteria throughout the body can occasionally lead to reactive arthritis. Although there has been an increase in the number of cases, there has not been a high rate of these complications in MSM.&lt;/p&gt;
&lt;p&gt;You can still pass the infection on to sexual partners if you don&amp;rsquo;t have symptoms.&lt;/p&gt;
&lt;p&gt;People who engage in receptive anal sex may have severe proctitis or proctocolitis with bloody purulent rectal discharge during the 1st stage. In the chronic stages, colitis simulating&amp;nbsp;Crohn disease&amp;nbsp;may cause tenesmus and strictures in the rectum or pain due to inflamed pelvic lymph nodes. Proctoscopy may detect diffuse inflammation, polyps, and masses or mucopurulent exudate&amp;mdash;findings that resemble inflammatory bowel disease.&amp;nbsp;&lt;/p&gt;
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&lt;h3&gt;&lt;strong&gt;Diagnostic Considerations&lt;/strong&gt;&lt;/h3&gt;
&lt;p&gt;Tests for chlamydia will also detect LGV infection, so a negative chlamydia test means no LGV infection. Chlamydia is diagnosed by checking a urine sample or taking swabs from affected areas, such as the rectum, urethra, vagina or throat.&lt;/p&gt;
&lt;p&gt;Diagnosis is based on clinical suspicion, epidemiologic information, and the exclusion of other etiologies for proctocolitis, inguinal lymphadenopathy, or genital or rectal ulcers. Genital lesions, rectal specimens, and lymph node specimens (i.e., lesion swab or bubo aspirate) can be tested for&amp;nbsp;&lt;em&gt;C. trachomatis&lt;/em&gt;&amp;nbsp;by culture, direct immunofluorescence, or nucleic acid detection&amp;nbsp;&lt;em&gt;&lt;a href=&quot;https://www.cdc.gov/std/tg2015/references.htm#394&quot;&gt;(394)&lt;/a&gt;&lt;/em&gt;. NAATs for&amp;nbsp;&lt;em&gt;C. trachomatis&lt;/em&gt;&amp;nbsp;perform well on rectal specimens, but are not FDA-cleared for this purpose. Many laboratories have performed the CLIA validation studies needed to provide results from rectal specimens for clinical management. MSM presenting with protocolitis should be tested for chlamydia; NAAT performed on rectal specimens is the preferred approach to testing.&lt;/p&gt;
&lt;p&gt;Additional molecular procedures (e.g., PCR-based genotyping) can be used to differentiate LGV from non-LGV&amp;nbsp;&lt;em&gt;C. trachomatis&lt;/em&gt;&amp;nbsp;in rectal specimens. However, they are not widely available, and results are not available in a timeframe that would influence clinical management.&lt;/p&gt;
&lt;p&gt;Chlamydia serology (complement fixation titers &amp;gt;1:64 or microimmunofluorescence titers &amp;gt;1:256) might support the diagnosis of LGV in the appropriate clinical context. Comparative data between types of serologic tests are lacking, and the diagnostic utility of these older serologic methods has not been established. Serologic test interpretation for LGV is not standardized, tests have not been validated for clinical proctitis presentations, and&amp;nbsp;&lt;em&gt;C. trachomatis&lt;/em&gt;&amp;nbsp;serovar-specific serologic tests are not widely available.&lt;/p&gt;
&lt;div class=&quot;para&quot;&gt;
&lt;p&gt;Lymphogranuloma venereum is suspected in patients who have genital ulcers, swollen inguinal lymph nodes, or proctitis and who live in, have visited, or have sexual contact with people from areas where infection is common. LGV is also suspected in patients with buboes, which may be mistaken for abscesses caused by other bacteria.&lt;/p&gt;
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&lt;div class=&quot;para&quot;&gt;
&lt;p&gt;Diagnosis has usually been made by detecting antibodies to chlamydial endotoxin (complement fixation titers &amp;gt; 1:64 or microimmunofluorescence titers &amp;gt; 1:256) or by genotyping using a polymerase chain reaction-based NAAT. Antibody levels are usually elevated at presentation or shortly thereafter and remain elevated.&lt;/p&gt;
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&lt;div class=&quot;para&quot;&gt;
&lt;p&gt;Direct tests for chlamydial antigens with immunoassays (eg, enzyme-linked immunosorbent assay [ELISA]) or with immunofluorescence using monoclonal antibodies to stain pus or NAATs may be available through reference laboratories (eg, Centers for Disease Control and Prevention in the US).&lt;/p&gt;
&lt;div class=&quot;para&quot;&gt;
&lt;p&gt;All sex partners should be evaluated.&lt;/p&gt;
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&lt;p&gt;After apparently successful treatment, patients should be followed for 6 months.&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;p class=&quot;p2&quot; style=&quot;text-align: center;&quot;&gt;&lt;a href=&quot;https://www.pulse-clinic.com/thailand-pcr-28-stds-promotion-std-test-bangkok-pattaya-phuket-hatyai-chiangmai&quot;&gt;&lt;strong&gt;&lt;span data-preserver-spaces=&quot;true&quot;&gt;All PULSE Clinics in Thailand provide the most comprehensive PCR Tests for 28 infections to give you peace of mind and fast treatment&lt;/span&gt;&lt;/strong&gt;&lt;/a&gt;&lt;span data-preserver-spaces=&quot;true&quot;&gt;.&amp;nbsp;&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;a href=&quot;https://pulse-clinic.com/thailand-pcr-28-stds-promotion-std-test-bangkok-pattaya-phuket-hatyai-chiangmai&quot;&gt;&lt;img src=&quot;https://cms.pulse-clinic.com/Files/PCR%20Multiplex/PUSLE%20PCR%2028%20Banner-2_readmore.jpg&quot; width=&quot;1456&quot; height=&quot;200&quot; style=&quot;display: block; margin-left: auto; margin-right: auto;&quot; /&gt;&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
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&lt;h3&gt;&lt;strong&gt;Treatment&lt;/strong&gt;&lt;/h3&gt;
&lt;p&gt;Most cases of LGV can be treated using a 21-day course of the oral antibiotic doxycycline. There are other antibiotics that will work against LGV if this is not suitable for some reason, but there are few interactions between doxycycline and&amp;nbsp;&lt;a href=&quot;http://www.aidsmap.com/Anti-HIV-drugs/page/1060104/&quot;&gt;anti-HIV drugs&lt;/a&gt;. Your symptoms should improve in one to two weeks after starting treatment, but it may take longer if you have had the infection for some time.&lt;/p&gt;
&lt;p class=&quot;cms-BoxOut&quot;&gt;It is important that you do not have sex if you have LGV, or any other sexually transmitted infection, until follow-up tests confirm that you no longer have the infection.&lt;/p&gt;
&lt;p&gt;Sexual partners who may have been at risk of infection should also, if possible,&amp;nbsp;be identified, tested and treated.&lt;/p&gt;
&lt;p&gt;It is possible to become infected with LGV again after being successfully treated. To avoid this, make sure any of your sexual partners have also been treated.&lt;/p&gt;
&lt;p&gt;At the time of the initial visit (before diagnostic tests for chlamydia are available), persons with a clinical syndrome consistent with LGV, including proctocolitis or genital ulcer disease with lymphadenopathy, should be presumptively treated for LGV. As required by state law, these cases should be reported to the health department.&lt;/p&gt;
&lt;p&gt;Treatment cures infection and prevents ongoing tissue damage, although tissue reaction to the infection can result in scarring. Buboes might require aspiration through intact skin or incision and drainage to prevent the formation of inguinal/femoral ulcerations.&lt;/p&gt;
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&lt;p&gt;&lt;span class=&quot;disabledResolvedDrug&quot;&gt;Doxycycline&lt;/span&gt;&amp;nbsp;100 mg orally twice a day,&amp;nbsp;&lt;span class=&quot;disabledResolvedDrug&quot;&gt;erythromycin&lt;/span&gt;&amp;nbsp;500 mg orally four times a day, or&amp;nbsp;&lt;span class=&quot;disabledResolvedDrug&quot;&gt;tetracycline&lt;/span&gt;&amp;nbsp;500 mg orally four times a day, each for 21 days, are effective for early disease.&amp;nbsp;&lt;span class=&quot;disabledResolvedDrug&quot;&gt;Azithromycin&lt;/span&gt;&amp;nbsp;1 g orally once a week for 1 to 3 weeks is probably effective, but neither it nor&amp;nbsp;&lt;span class=&quot;disabledResolvedDrug&quot;&gt;clarithromycin&lt;/span&gt;&amp;nbsp;has been adequately evaluated.&lt;/p&gt;
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&lt;p&gt;Swelling of damaged tissues in later stages may not resolve despite elimination of the bacteria. Buboes may be drained by needle or surgically if necessary for symptomatic relief, but most patients respond quickly to antibiotics. Buboes and sinus tracts may require surgery, but rectal strictures can usually be dilated.&lt;/p&gt;
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&lt;div class=&quot;para&quot;&gt;
&lt;p&gt;If people have sexual contact with a person who has lymphogranuloma venereum during the 60 days before the person&#39;s symptoms began, they should be examined and tested for urethral, cervical, or rectal chlamydial infection depending on the site of exposure. They should be treated presumptively (with a single dose of&amp;nbsp;&lt;span class=&quot;disabledResolvedDrug&quot;&gt;azithromycin&lt;/span&gt;&amp;nbsp;1 g orally or&amp;nbsp;&lt;span class=&quot;disabledResolvedDrug&quot;&gt;doxycycline&lt;/span&gt;&amp;nbsp;100 mg orally twice a day for 7 days) regardless of whether evidence suggests that they have LGV.&lt;/p&gt;
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&lt;h4&gt;&lt;em&gt;Recommended Regimen&lt;/em&gt;&lt;/h4&gt;
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&lt;li&gt;Doxycycline 100 mg orally twice a day for 21 days&lt;/li&gt;
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&lt;h4&gt;&lt;em&gt;Alternative Regimen&lt;/em&gt;&lt;/h4&gt;
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&lt;li&gt;Erythromycin base 500 mg orally four times a day for 21 days&lt;/li&gt;
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&lt;p&gt;All sex partners should be evaluated.&lt;br /&gt;After apparently successful treatment, patients should be followed for 6 months.&lt;/p&gt;
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&lt;p&gt;Patients should be followed clinically until signs and symptoms have resolved. Persons who receive an LGV diagnosis should be tested for other STDs, especially HIV, gonorrhea, and syphilis. Those who test positive for another infection should be referred for or provided with appropriate care and treatment.&lt;/p&gt;
&lt;h3&gt;&lt;strong&gt;Follow-up&lt;/strong&gt;&lt;/h3&gt;
&lt;p&gt;Patients should be followed clinically until signs and symptoms resolve.&lt;/p&gt;
&lt;h3&gt;&lt;strong&gt;Management of Sex Partners&lt;/strong&gt;&lt;/h3&gt;
&lt;p&gt;Persons who have had sexual contact with a patient who has LGV within the 60 days before onset of the patient&amp;rsquo;s symptoms should be examined and tested for urethral, cervical, or rectal chlamydial infection depending on anatomic site of exposure. They should be presumptively treated with a chlamydia regimen (azithromycin 1 g orally single dose or doxycycline 100 mg orally twice a day for 7 days).&lt;/p&gt;
&lt;h3&gt;&lt;a id=&quot;spec-con&quot;&gt;&lt;/a&gt;&lt;span style=&quot;color: #ff0000;&quot;&gt;&lt;strong&gt;Special Considerations&lt;/strong&gt;&lt;/span&gt;&lt;/h3&gt;
&lt;h4&gt;&lt;strong&gt;Pregnancy&lt;/strong&gt;&lt;/h4&gt;
&lt;p&gt;Pregnant and lactating women should be treated with erythromycin. Doxycycline should be avoided in the second and third trimester of pregnancy because of risk for discoloration of teeth and bones, but is compatible with breastfeeding&amp;nbsp;&lt;em&gt;&lt;a href=&quot;https://www.cdc.gov/std/tg2015/references.htm#317&quot;&gt;(317)&lt;/a&gt;&lt;/em&gt;. Azithromycin might prove useful for treatment of LGV in pregnancy, but no published data are available regarding an effective dose and duration of treatment.&lt;/p&gt;
&lt;h4&gt;&lt;a id=&quot;hiv&quot;&gt;&lt;/a&gt;&lt;strong&gt;HIV Infection&lt;/strong&gt;&lt;/h4&gt;
&lt;p&gt;Persons with both LGV and HIV infection should receive the same regimens as those who are HIV negative. Prolonged therapy might be required, and delay in resolution of symptoms might occur.&lt;/p&gt;
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&lt;p class=&quot;p2&quot; style=&quot;text-align: center;&quot;&gt;&lt;a href=&quot;https://www.pulse-clinic.com/thailand-pcr-28-stds-promotion-std-test-bangkok-pattaya-phuket-hatyai-chiangmai&quot;&gt;&lt;strong&gt;&lt;span data-preserver-spaces=&quot;true&quot;&gt;All PULSE Clinics in Thailand provide the most comprehensive PCR Tests for 28 infections to give you peace of mind and fast treatment&lt;/span&gt;&lt;/strong&gt;&lt;/a&gt;&lt;span data-preserver-spaces=&quot;true&quot;&gt;.&amp;nbsp;&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;a href=&quot;https://pulse-clinic.com/thailand-pcr-28-stds-promotion-std-test-bangkok-pattaya-phuket-hatyai-chiangmai&quot;&gt;&lt;img src=&quot;https://cms.pulse-clinic.com/Files/PCR%20Multiplex/PUSLE%20PCR%2028%20Banner-2_readmore.jpg&quot; width=&quot;1456&quot; height=&quot;200&quot; style=&quot;display: block; margin-left: auto; margin-right: auto;&quot; /&gt;&lt;/a&gt;&lt;/p&gt;

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LGV Lymphogranuloma Venereum Treatment in Thailand

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