eMedicine Specialties > Dermatology > Bacterial Infections

Lymphogranuloma Venereum: Differential Diagnoses & Workup

Author: Jose Antonio Plaza, MD, Director of Dermatopathology, Department of Pathology, Froedtert Hospital; Assistant Professor, Department of Pathology, Section of Dermatopathology, Medical College of Wisconsin
Coauthor(s): Victor G Prieto, MD, PhD, Director of Dermatopathology, Professor, Departments of Pathology and Dermatology, University of Texas MD Anderson Cancer Center
Contributor Information and Disclosures

Updated: Sep 2, 2009

Differential Diagnoses

Catscratch Disease
Chancroid
Granuloma Inguinale (Donovanosis)
Syphilis

Other Problems to Be Considered

Primary lesion
Genital herpes
Primary syphilis
Chancroid

Genitoanorectal syndrome
Crohn disease
Rectal strictures resulting from carcinoma

Workup

Laboratory Studies

  • Lymphogranuloma venereum (LGV) diagnosis is hampered by the difficulty in culturing the organism. The best results have been obtained using aspirates from an involved inguinal lymph node and from bacterial typing of the culture after growth. Culture requires growth in cycloheximide-treated McCoy or HeLa cells, and even under these conditions, yields of only 30-50% are reported.
  • Serologic tests for LGV also are available and produce a strong reaction by complement fixation. Tests typically are positive within 2 weeks of disease onset and have a sensitivity of 80%. The difficulty is in separating the various serotypes of Chlamydia species, including those involved in conjunctivitis; however, in the appropriate clinical setting, an antibody titer of 1:64 or greater or a 4-fold increase in titer is supportive of an LGV diagnosis. Other types of chlamydial infections rarely demonstrate a titer of greater than 1:16. Antibody titers do not correlate well with clinical severity of the disease.
  • Other testing modalities for LGV include microimmunofluorescence and polymerase chain reaction (PCR). The usefulness of these methods is limited by availability.6,7,8

Other Tests

  • Other testing in lymphogranuloma venereum (LGV) may include screening for coexistence of other sexually transmitted diseases (STDs).
  • As with all STDs, consider concomitant infections and perform screening tests.

Procedures

  • Necessary procedures for lymphogranuloma venereum (LGV) may include aspiration of buboes to speed healing and relieve discomfort.

Histologic Findings

The histologic features of the initial lymphogranuloma venereum (LGV) genital papule are generally nonspecific (ulceration and granulation tissue in dermis). In the lymph nodes, stellate abscesses with surrounding epithelioid cells and macrophage giant cells represent the characteristic lesion. Special stains do not demonstrate the infecting organism in skin or lymph nodes. Tissue cultures of a skin lesion or lymph node are necessary to demonstrate the infection.

More on Lymphogranuloma Venereum

Overview: Lymphogranuloma Venereum
Differential Diagnoses & Workup: Lymphogranuloma Venereum
Treatment & Medication: Lymphogranuloma Venereum
Follow-up: Lymphogranuloma Venereum
References
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References

  1. Bremer V, Meyer T, Marcus U, Hamouda O. Lymphogranuloma venereum emerging in men who have sex with men in Germany. Euro Surveill. Sep 2006;11(9):152-4. [Medline].

  2. Herida M, de Barbeyrac B, Sednaoui P, et al. Rectal lymphogranuloma venereum surveillance in France 2004-2005. Euro Surveill. Sep 2006;11(9):155-6. [Medline].

  3. Kapoor S. Re-emergence of lymphogranuloma venereum. J Eur Acad Dermatol Venereol. Apr 2008;22(4):409-16. [Medline].

  4. Klint M, Lofdahl M, Ek C, Airell A, Berglund T, Herrmann B. Lymphogranuloma venereum prevalence in Sweden among men who have sex with men and characterization of Chlamydia trachomatis ompA genotypes. J Clin Microbiol. Nov 2006;44(11):4066-71. [Medline].

  5. van de Laar MJ. The emergence of LGV in western Europe: what do we know, what can we do?. Euro Surveill. Sep 2006;11(9):146-8. [Medline].

  6. Chen CY, Chi KH, Alexander S, et al. The molecular diagnosis of lymphogranuloma venereum: evaluation of a real-time multiplex polymerase chain reaction test using rectal and urethral specimens. Sex Transm Dis. Jul 2007;34(7):451-5. [Medline].

  7. Hadfield TL, Lamy Y, Wear DJ. Demonstration of Chlamydia trachomatis in inguinal lymphadenitis of lymphogranuloma venereum: a light microscopy, electron microscopy and polymerase chain reaction study. Mod Pathol. Dec 1995;8(9):924-9. [Medline].

  8. Klotz SA, Drutz DJ, Tam MR, Reed KH. Hemorrhagic proctitis due to lymphogranuloma venereum serogroup L2. Diagnosis by fluorescent monoclonal antibody. N Engl J Med. Jun 30 1983;308(26):1563-5. [Medline].

  9. Gilleece Y, Sullivan A. Management of sexually transmitted infections in HIV positive individuals. Curr Opin Infect Dis. Feb 2005;18(1):43-7. [Medline].

  10. [Guideline] Lymphogranuloma venereum (LVG). New York State Department of Health. National Guidelines Clearinghouse. Aug 2007.

  11. [Guideline] U.S. Preventive Services Task Force. Behavioral counseling to prevent sexually transmitted infections: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. Oct 7 2008;149(7):491-6, W95. [Medline].

  12. Blank S, Schillinger JA, Harbatkin D. Lymphogranuloma venereum in the industrialised world. Lancet. May 7-13 2005;365(9471):1607-8. [Medline].

  13. Brown TJ, Yen-Moore A, Tyring SK. An overview of sexually transmitted diseases. Part I. J Am Acad Dermatol. Oct 1999;41(4):511-32. [Medline].

  14. Burgoyne RA. Lymphogranuloma venereum. Prim Care. Mar 1990;17(1):153-7. [Medline].

  15. Den Hollander JG, Ossewaarde JM, de Marie S. Anorectal ulcer in HIV patients, don't forget lymphogranuloma venereum!. AIDS. Jul 2 2004;18(10):1484-5. [Medline].

  16. Joseph AK, Rosen T. Laboratory techniques used in the diagnosis of chancroid, granuloma inguinale, and lymphogranuloma venereum. Dermatol Clin. Jan 1994;12(1):1-8. [Medline].

  17. Kellock DJ, Barlow R, Suvarna SK, Green S, Eley A, Rogstad KE. Lymphogranuloma venereum: biopsy, serology, and molecular biology. Genitourin Med. Oct 1997;73(5):399-401. [Medline].

  18. Martin DH, Mroczkowski TF. Dermatologic manifestations of sexually transmitted diseases other than HIV. Infect Dis Clin North Am. Sep 1994;8(3):533-82. [Medline].

  19. Martin IM, Alexander SA, Ison CA, Macdonald N, McCarthy K, Ward H. Diagnosis of lymphogranuloma venereum from biopsy samples. Gut. Oct 2006;55(10):1522-3. [Medline].

  20. McLean CA, Stoner BP, Workowski KA. Treatment of Lymphogranuloma Venereum. Clinical Infectious Diseases. 2007;44:S147–S152.

  21. Papagrigoriadis S, Rennie JA. Lymphogranuloma venereum as a cause of rectal strictures. Postgrad Med J. Mar 1998;74(869):168-9. [Medline].

  22. Rosen T, Brown TJ. Cutaneous manifestations of sexually transmitted diseases. Med Clin North Am. Sep 1998;82(5):1081-104, vi. [Medline].

  23. Simms I, Ward H, Martin I, Alexander S, Ison C. Lymphogranuloma venereum in Australia. Sex Health. Sep 2006;3(3):131-3. [Medline].

  24. Sternberg SJ. The penis. Diagn Surg Pathol. 1999;2(3):2039-40.

  25. Sturm PD, Moodley P, Govender K, Bohlken L, Vanmali T, Sturm AW. Molecular diagnosis of lymphogranuloma venereum in patients with genital ulcer disease. J Clin Microbiol. Jun 2005;43(6):2973-5. [Medline].

  26. Trager JD. Sexually transmitted diseases causing genital lesions in adolescents. Adolesc Med Clin. Jun 2004;15(2):323-52. [Medline].

  27. Van Vranken M. Prevention and treatment of sexually transmitted diseases: an update. Am Fam Physician. Dec 2007;15;76(12):1827-32.

  28. Weir E. Lymphogranuloma venereum in the differential diagnosis of proctitis. CMAJ. Jan 18 2005;172(2):185. [Medline].

  29. White J, Ison C. Lymphogranuloma venereum: what does the clinician need to know?. Clin Med. Jun 2008;8(3):327-30. [Medline].

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Further Reading

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Keywords

lymphogranuloma venereum, LGV, Chlamydia trachomatis, C trachomatis, STD, sexually transmitted chlamydial disease, sexually transmitted disease, chlamydia

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Contributor Information and Disclosures

Author

Jose Antonio Plaza, MD, Director of Dermatopathology, Department of Pathology, Froedtert Hospital; Assistant Professor, Department of Pathology, Section of Dermatopathology, Medical College of Wisconsin
Jose Antonio Plaza, MD is a member of the following medical societies: American Medical Association and American Society for Clinical Pathology
Disclosure: Nothing to disclose.

Coauthor(s)

Victor G Prieto, MD, PhD, Director of Dermatopathology, Professor, Departments of Pathology and Dermatology, University of Texas MD Anderson Cancer Center
Victor G Prieto, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science, American Medical Association, American Society for Clinical Pathology, American Society of Dermatopathology, College of American Pathologists, European Society of Pathology, International Society of Dermatopathology, Society for Investigative Dermatology, and United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Medical Editor

Terry L Barrett, MD, Clinical Professor of Dermatology and Pathology, University of Texas Southwestern School of Medicine; Director, ProPath Dermatopathology, Dallas, Texas
Terry L Barrett, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society of Dermatopathology, College of American Pathologists, and United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Lester F Libow, MD, Dermatopathologist, South Texas Dermatopathology Laboratory
Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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