Lymphogranuloma Venereum in Emergency Medicine Workup

  • Author: Andrew C Bushnell, MD, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Aug 17, 2009
 

Laboratory Studies

  • Initial laboratory analysis may reveal mild leukocytosis.
  • These nonspecific results do not aid the clinician in the diagnosis of lymphogranuloma venereum (LGV).
  • Previously, the Frei test was the only method available to identify a chlamydial infection. Currently, the Frei intradermal test is only of historical interest.
    • The test was based on a positive hypersensitivity to an intradermal standardized antigen, lymphogranuloma venereum, which indicated past or present chlamydial infection. The Frei test would become positive 2-8 weeks after infection.
    • Unfortunately, the Frei antigen is common to all chlamydial species and is not specific to LGV. Commercial manufacturing of Frei antigen was discontinued in 1974.
  • Complement fixation (CF) is more sensitive than the Frei skin test, but it has some cross-reactivity with other chlamydial species.
    • CF sensitivity is 80% for LGV.
    • A test titer of 1:16 is strongly suggestive of LGV and a titer of >1:64 indicates active LGV.
    • A 4-fold rise or fall in titer further supports the diagnosis.
  • The microimmunofluorescence test for the L-type serovar of C trachomatis is a more sensitive and specific test. A titer greater or equal to 1:512 is diagnostic. Availability of this test is the limiting factor.
  • Application of nucleic acid amplification techniques have been used to confirm the diagnosis with much greater certainty. Polymerase chain reaction (PCR) assays have been used for diagnosis recently in several outbreaks. PCR is a far superior test but has limited availability to reference laboratories. Recently, multiplexed real-time PCR assays have been developed for the rapid detection of Chlamydia trachomatis and specific serovars.[2] As these tests are refined and approved for widespread use, they will speed detection and diagnosis.
  • Dermatopathology is not pathognomonic for LGV, and cytology using Giemsa stain or iodine stain fails to provide a high percentage of diagnoses.
  • Definitive diagnosis may be made by aspiration of the bubo and growth of the aspirated material in cell culture. C trachomatis can be cultured in as many as 30% of cases.
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Imaging Studies

  • CT scan may be useful if retroperitoneal adenitis or intraabdominal abscess is suspected, but it is rarely necessary in the ED.
  • Lymphography does not outline buboes, but it may demonstrate the extent of lymph node involvement. This rarely is ordered in the ED.
  • A barium enema may reveal the characteristic elongated stricture in rectal LGV.
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Other Tests

  • Venereal Disease Research Laboratory (VDRL) test or rapid plasma reagin (RPR), PCR assays for Haemophilus ducreyi and HSV-2, and HIV antibodies should be considered because patients with LGV may also have contracted other sexually transmitted diseases.
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Procedures

  • A bubo may be aspirated to speed the healing, but this is not necessary for culture since other diagnostic methods are more sensitive and specific.
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Contributor Information and Disclosures
Author

Andrew C Bushnell, MD, FACEP  Department of Surgery, Division of Emergency Medicine, Assistant Professor, University of Vermont College of Medicine

Andrew C Bushnell, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Eric M Kardon, MD, FACEP  Attending Emergency Physician, Georgia Emergency Medicine Specialists; Physician, Division of Emergency Medicine, Athens Regional Medical Center

Eric M Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Jeter (Jay) Pritchard Taylor III, MD  Compliance Officer, Attending Physician, Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina School of Medicine; Medical Director, Department of Emergency Medicine, Palmetto Health Baptist

Jeter (Jay) Pritchard Taylor III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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