eMedicine Specialties > Infectious Diseases > Sexually Transmitted Diseases

Lymphogranuloma Venereum (LGV): Treatment & Medication

Author: Alexandre F Migala, DO, Staff Physician, Department of Emergency Medicine, Denton Regional Medical Center
Contributor Information and Disclosures

Updated: May 15, 2009

Treatment

Medical Care

The complete treatment of patients with LGV includes appropriate antimicrobial coverage and drainage of infected buboes.

  • The recommended medical treatment for LGV involves one of the following antibiotic regimens:
    • Doxycycline 100 mg PO bid for 21 d
    • Erythromycin base 500 mg PO qid for 21 d

Surgical Care

Needle aspiration or incision and drainage of involved inguinal nodes may be required for pain relief and prevention of ulcer formation. Some of the late complications of the third stage of LGV may require surgical repair.

Consultations

Surgical consultation for lymphadenopathy is generally not required unless extensive buboes require further exploration. For tertiary disease, appropriate surgical consultation is indicated.

Activity

No restrictions to physical activities are required; however, patients should abstain from sexual contact until the infection resolves completely.

Medication

The goal of therapy is to eradicate the organism.

Antibiotics

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. Totally eradicate the causative organism or organisms.


Doxycycline (Bio-Tab, Doxy, Doryx, Vibramycin, Vibra-Tabs)

Inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.

Adult

200 mg PO/IV immediately and 100 mg hs, followed by 100 mg bid for 3 d; alternatively, 100-200 mg PO bid for 14 d

Pediatric

<8 years: Not recommended
>8 years: 2-5 mg/kg/d PO/IV qd or divided bid; not to exceed 200 mg/d

Bioavailability minimally decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; tetracyclines can increase hypoprothrombinemic effects of anticoagulants; tetracyclines can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy

Documented hypersensitivity; severe hepatic dysfunction

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Photosensitivity may occur rarely; tetracycline use during tooth development (last half of pregnancy through age 8 y) can cause permanent discoloration of teeth


Erythromycin (E.E.S., E-Mycin, Eryc, Ery-Tab, Erythrocin)

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest. For treatment of staphylococcal and streptococcal infections. In children, age, weight, and severity of infection determine proper dosage. When bid dosing is desired, half of the total daily dose may be taken q12h. For more severe infections, double the dose.

Adult

250 mg erythromycin stearate/base (or 400 mg ethylsuccinate) PO q6h 1 h ac or 500 mg q12h; alternatively, 333 mg PO q8h; increase to 4 g/d depending on severity of infection

Pediatric

30-50 mg/kg/d (15-25 mg/lb/d) PO divided q6-8h; double dose for severe infection

Coadministration may increase toxicity of theophylline, digoxin, carbamazepine, and cyclosporine; may potentiate anticoagulant effects of warfarin; coadministration with lovastatin and simvastatin increases risk of rhabdomyolysis

Documented hypersensitivity; hepatic impairment

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in liver disease; estolate formulation may cause cholestatic jaundice; adverse GI effects are common (administer doses pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occur

More on Lymphogranuloma Venereum (LGV)

Overview: Lymphogranuloma Venereum (LGV)
Differential Diagnoses & Workup: Lymphogranuloma Venereum (LGV)
Treatment & Medication: Lymphogranuloma Venereum (LGV)
Follow-up: Lymphogranuloma Venereum (LGV)
References
Further Reading
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References

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  2. CDC. Lymphogranuloma venereum among men who have sex with men--Netherlands, 2003-2004. MMWR Morb Mortal Wkly Rep. 2004;53:985-988. [Medline].

  3. Stary G, Stary A. Lymphogranuloma venereum outbreak in Europe. J Dtsch Dermatol Ges. Nov 2008;6(11):935-40. [Medline].

  4. Gomes JP, Nunes A, Florindo C, Ferreira MA, Santo I, Azevedo J, et al. Lymphogranuloma venereum in Portugal: unusual events and new variants during 2007. Sex Transm Dis. Feb 2009;36(2):88-91. [Medline].

  5. Sethi G, Allason-Jones E, Richens J, Annan NT, Hawkins D, Ekbote A, et al. Lymphogranuloma venereum presenting as genital ulceration and inguinal syndrome in men who have sex with men in London, United Kingdom. Sex Transm Infect. Dec 9 2008;[Medline].

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  8. Ward H, Alexander S, Carder C, Dean G, French P, Ivens D, et al. The prevalence of Lymphogranuloma venereum (LGV) infection in men who have sex with men: results of a multi-centre case finding study. Sex Transm Infect. Feb 15 2009;[Medline].

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Further Reading

Clinical guidelines

Lymphogranuloma venereum (LGV).
New York State Department of Health - State/Local Government Agency [U.S.]. 2007 Aug. 11 pages. NGC:005903

2006 national guideline for the management of lymphogranuloma venereum.
British Association for Sexual Health and HIV - Medical Specialty Society. 1999 Aug (revised 2006 May). 14 pages. NGC:006016

Lymphogranuloma venereum (LGV). In: Sexually transmitted infections: UK national screening and testing guidelines.
British Association for Sexual Health and HIV - Medical Specialty Society. 2006 Aug. 6 pages. NGC:006400

Related eMedicine topics

Lymphogranuloma Venereum (Emergency Medicine)

Lymphogranuloma Venereum (Dermatology)

Chlamydia

Dermatologic Diseases of the Male Genitalia: Nonmalignant

Perianal Granuloma

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Keywords

lymphogranuloma venereum, LVG, sexually transmitted disease, STD, sexually transmitted infection, STI, Chlamydia trachomatis, C trachomatis, venereal disease, VD, HIV, AIDS, herpes simplex virus, HSV, syphilis, inguinal lymphadenopathy, genital papule, genital pustule, proctocolitis, genital ulcer disease, rectal stenosis, perirectal fissures, lymphorrhoids, elephantiasis, rectal adenocarcinoma, genitoanorectal syndrome, bubo, buboes, esthiomene, saxophone penis

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Contributor Information and Disclosures

Author

Alexandre F Migala, DO, Staff Physician, Department of Emergency Medicine, Denton Regional Medical Center
Alexandre F Migala, DO is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Osteopathic Association, Association of Military Osteopathic Physicians and Surgeons, and Texas Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Kenneth C Earhart, MD, Deputy Head, Disease Surveillance Program, United States Naval Medical Research Unit #3
Kenneth C Earhart, MD is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and Undersea and Hyperbaric Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Charles V Sanders, MD, Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center
Charles V Sanders, MD is a member of the following medical societies: Alliance for the Prudent Use of Antibiotics, Alpha Omega Alpha, American Association for the Advancement of Science, American Association of University Professors, American Clinical and Climatological Association, American College of Physician Executives, American College of Physicians, American Federation for Medical Research, American Foundation for AIDS Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association for Professionals in Infection Control and Epidemiology, Association of American Medical Colleges, Association of American Physicians, Association of Professors of Medicine, Infectious Disease Society for Obstetrics and Gynecology, Infectious Diseases Society of America, Louisiana State Medical Society, Orleans Parish Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southeastern Clinical Club, Southern Medical Association, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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