Approach Considerations

Testing for LGV is complicated by the lack of widely available serovar specific testing. Diagnosis is often made on the basis of clinical presentation, epidemiologic risk factors, the results of available Chlamydial trachomatis NAAT testing, and exclusion of alternative diagnoses. Serologic testing for specific serovars of LGV is discussed below, but is often not practical due to lack of availability and need to make clinical decisions sooner than data would return. ^[30]

Laboratory Studies

Laboratory diagnosis ultimately depends on detecting C trachomatis– specific DNA, followed by genotyping to identify serovars L1, L2, or L3 found in LGV.

Diagnosis is based primarily on clinical findings, with increasing evidence supporting the use of nucleic acid amplification tests (NAATs) for confirmation. Serologic testing is problematic because of the difficulty in culturing the organism and cross-reactivity of the many different serotypes.

Needle aspiration of an involved bubo is the best method to obtain tissue for culture.

Culture of C trachomatis, while definitive diagnostically, is technically demanding and expensive and yields an isolate only 30% of the time.

Because of its systemic nature, the disease produces a strong immunologic response that is readily evident on complement fixation testing.

Cross-reactivity between various chlamydial infections occurs on complement fixation testing.

Chlamydial urethritis, cervicitis, or conjunctivitis rarely produce serologic complement fixation titers greater than 1:16. LGV titers are usually more than 1:1024.

A serum complement fixation titer greater than 1:64, when coupled with the appropriate clinical scenario, is considered diagnostic of LGV.^[30]

Immunofluorescent testing with monoclonal antibodies and polymerase chain reaction (PCR) testing are also reported to be effective; however, these tests are not widely available for commercial use.^[31]

NAATs have shown significant promise in revealing the presence of Chlamydia. Several commercially available NAATS used to identify the presence of Chlamydia in urine demonstrated an increased sensitivity and specificity that ranged from 96-100% and 99.1-100%, respectively.^[32]These assays are cleared for use by the US Food and Drug Administration (FDA) with cervical swabs, male urethral swabs, and urine specimens.

Procedures

Needle aspiration of involved buboes may be performed to ease discomfort or to obtain tissue for culture.

Histologic Findings

Histologic findings of lymph node biopsies performed in the second and third stages of the disease typically reveal stellate abscesses.

Treatment & Management

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