Lymphogranuloma Venereum (LGV) in Emergency Medicine Guidelines

Updated: Apr 02, 2021
  • Author: Kristyn J Smith, DO; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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World Health Organization (WHO) Guidelines on the Treatment of Lymphogranuloma Venereum

WHO recommendations for the treatment of lymphogranuloma venereum (LGV) are as follows [16] :

  • In adults and adolescents with LGV, the guidelines suggest doxycycline 100 mg orally twice daily for 21 days over azithromycin 1 g orally weekly for 3 weeks.
  • Good practice dictates treatment of LGV, particularly for men who have sex with men and for people with HIV infection.
  • When doxycycline is contraindicated, azithromycin should be provided.
  • When neither treatment is available, erythromycin 500 mg orally 4 times a day for 21 days is an alternative.
  • Doxycycline should not be used in pregnant women.



Infectious Disease Society of America Guidelines on the Treatment of Lymphogranuloma Venereum

The Infectious Disease Society of America (IDSA) recommends doxycycline 100 mg orally twice daily for 21 days as first-line treatment. [17]  No clinical studies currently support azithromycin for treatment.


Centers for Disease Control and Prevention (CDC) - Lymphogranuloma Venereum - 2015 STD Guidelines


The CDC recommends patients with symptoms concerning for LGV be treated as follows [18] :

  • Doxycycline 100mg orally twice a day for 21 days 
  • Alternative Regimen: Erythromycin 500mg orally four times a day for 21 days. Erythromycin is the preferred treatment for patients who are lactating or in their second or third trimesters of pregnancy.  
  • If Doxycycline and Erythromycin are contraindicated, Azithromycin 1g once a week for 3 weeks may be considered. Clinical data on the efficacy of azithromycin is lacking. This regimen is presumed based on the known chlamydial antimicrobial activity of Azithromycin. 

Depending on state laws, cases of LGV should be reported to the health department. Until clinical symptoms resolve, patients should be monitored with frequent follow-up appointments. Testing for HIV, syphilis, gonorrhea, and hepatitis B should be performed for all patients with a presumed LGV diagnosis.