Lymphogranuloma Venereum: Correct Diagnosis Makes all the Difference
Avnish Sandhu, DO; Deborah Richmond, CNP; Brian Reed; Jonathan Cohn, MD; Lawrence Crane, MD; Jennifer Veltman, MD.Wayne State University, Detroit, MI, USA
Background: Lymphogranuloma venereum (LGV) is a sexually transmitted infection that is rare in United States. There is no FDA approved test to differentiate Chlamydia trachomatis (CT) infections caused by LGV serovars making diagnosis challenging. This study characterizes the difficulties of diagnosing LGV during an outbreak in Southeast Michigan.
Methods: We performed a retrospective chart review of patients who met CDC criteria for confirmed and probable LGV at one of the Wayne State University ID Clinics between 8/2015 and 3/2018. Presenting symptoms, initial diagnoses, diagnostic testing, interval between onset of symptoms and LGV diagnosis, and treatment were reviewed. IRB exemption was obtained.
Results: Of 39 patients with LGV, 8 (20%) were probable cases and 31 (80%) were PCR confirmed at CDC. All patients were men having sex with men (MSM) and 38 were HIV infected. In 22 patients (56%) LGV was considered likely at presentation whereas in 17 (44%) patients LGV was not initially considered. 11 (66%) patients with a delayed diagnosis had 14 unnecessary diagnostic tests ordered, including computed tomography (6), colonoscopy (7) and renogram (1); only 3 (14%) with a correct early diagnosis had such tests (p=<0.001). 15 (88%) of those with a delayed diagnosis received inappropriate treatment compared with none of those with an initial LGV diagnosis (p=<0.0001). Correct treatment occurred 43 days after presentation in those with a delayed diagnosis whereas the early diagnosis patients were treated on the day of presentation (p=<0.0001). All 39 patients eventually received 21 days of doxycycline and experienced resolution of symptoms.
Conclusion: LGV is rare in the U.S., its clinical presentation in MSM is not well known, and proof requires unlicensed tests. More education is needed so that clinicians consider the diagnosis in MSM with a typical syndrome, start treatment promptly and avoid unnecessary tests.
B. Reed, None
J. Cohn, None
L. R. Crane, None
J. Veltman, Jansen: Speaker's Bureau , Speaker Bureau payment .