Dermatologic Manifestations of Lymphogranuloma Venereum Workup

Updated: May 10, 2018
  • Author: Jose A Plaza, MD; Chief Editor: Dirk M Elston, MD  more...
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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). [11] The usefulness of these methods is limited by availability. [12, 13, 14]

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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.

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Procedures

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

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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.

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