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.

Medication

Ceovic R, Gulin SJ. Lymphogranuloma venereum: diagnostic and treatment challenges. Infect Drug Resist. 2015. 8:39-47. [QxMD MEDLINE Link].
COUTTS WE. Lymphogranuloma venereum; a general review. Bull World Health Organ. 1950. 2 (4):545-62. [QxMD MEDLINE Link].
de Vries HJC, de Barbeyrac B, de Vrieze NHN, Viset JD, White JA, Vall-Mayans M, et al. 2019 European guideline on the management of lymphogranuloma venereum. J Eur Acad Dermatol Venereol. 2019 Oct. 33 (10):1821-1828. [QxMD MEDLINE Link].
Ilyas S, Richmond D, Burns G, Bowden KE, Workowski K, Kersh EN, et al. Orolabial Lymphogranuloma Venereum, Michigan, USA. Emerg Infect Dis. 2019 Nov. 25 (11):2112-2114. [QxMD MEDLINE Link].
de Voux A, Kent JB, Macomber K, et al. Notes from the Field: Cluster of Lymphogranuloma Venereum Cases Among Men Who Have Sex with Men — Michigan, August 2015–April 2016. MMWR Morb Mortal Wkly Rep. September 2, 2016. Available at https://www.cdc.gov/mmwr/volumes/65/wr/mm6534a6.htm.
Lee DM, Fairley CK, Owen L, Horvath L, Chen MY. Lymphogranuloma venereum becomes an established infection among men who have sex with men in Melbourne. Aust N Z J Public Health. 2009 Feb. 33(1):94. [QxMD MEDLINE Link].
Saxon C, Hughes G, Ison C, UK LGV Case-Finding Group. Asymptomatic Lymphogranuloma Venereum in Men who Have Sex with Men, United Kingdom. Emerg Infect Dis. 2016 Jan. 22 (1):112-116. [QxMD MEDLINE Link]. [Full Text].
Haar K, Dudareva-Vizule S, Wisplinghoff H, Wisplinghoff F, Sailer A, Jansen K, et al. Lymphogranuloma venereum in men screened for pharyngeal and rectal infection, Germany. Emerg Infect Dis. 2013 Mar. 19(3):488-92. [QxMD MEDLINE Link].
Templeton DJ, Sharp N, Gryllis S, O'Connor CC, Dubedat SM. Prevalence and predictors of lymphogranuloma venereum among men who have sex with men at a Sydney metropolitan sexual health clinic. Sex Health. 2013 Apr. 10(2):190-1. [QxMD MEDLINE Link].
Basta-Juzbašić A, Čeović R. Chancroid, lymphogranuloma venereum, granuloma inguinale, genital herpes simplex infection, and molluscum contagiosum. Clin Dermatol. 2014 Mar-Apr. 32 (2):290-8. [QxMD MEDLINE Link].
Rönn M, Hughes G, Simms I, Ison C, Alexander S, White PJ, et al. Challenges Presented by Re-Emerging Sexually Transmitted Infections in HIV Positive Men who have Sex with Men: An Observational Study of Lymphogranuloma Venereum in the UK. J AIDS Clin Res. 2014 Aug 1. 5 (8):1000329. [QxMD MEDLINE Link].
Rawla P, Thandra KC, Limaiem F. Lymphogranuloma Venereum. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Dec 11 2020. 1-8. [Full Text].
Halse TA, Musser KA, Limberger RJ. A multiplexed real-time PCR assay for rapid detection of Chlamydia trachomatis and identification of serovar L-2, the major cause of Lymphogranuloma venereum in New York. Mol Cell Probes. 2006 Oct. 20(5):290-7. [QxMD MEDLINE Link].
Arnold CA, Limketkai BN, Illei PB, Montgomery E, Voltaggio L. Syphilitic and lymphogranuloma venereum (LGV) proctocolitis: clues to a frequently missed diagnosis. Am J Surg Pathol. 2013 Jan. 37(1):38-46. [QxMD MEDLINE Link].
McLean CA, Stoner BP, Workowski KA. Treatment of lymphogranuloma venereum. Clin Infect Dis. 2007 Apr 1. 44 Suppl 3:S147-52. [QxMD MEDLINE Link]. [Full Text].
[Guideline] World Health Organization. WHO Guidelines for the Treatment of Chlamydia trachomatis. World Health Organization. 2016. [QxMD MEDLINE Link]. [Full Text].
GREAVES AB, HILLEMAN MR, TAGGART SR, BANKHEAD AB, FELD M. Chemotherapy in bubonic lymphogranuloma venereum: a clinical and serological evaluation. Bull World Health Organ. 1957. 16 (2):277-89. [QxMD MEDLINE Link]. [Full Text].
Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines - Lymphogranuloma Venereum (LGV). MMWR Recommendation Report. 2015. 64(No. RR-3): 1-137. Available at https://www.cdc.gov/std/tg2015/lgv.htm#:~:text=Persons%20who%20have%20had%20sexual,on%20anatomic%20site%20of%20exposure..

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Kristyn J Smith, DO Clinical Assistant Professor of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania; Physician, Department of Emergency Medicine, Hospital of the University of Pennsylvania and Hospital of the University of Pennsylvania-- Cedar

Kristyn J Smith, DO is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Medical Women's Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Jeter (Jay) Pritchard Taylor, III, MD Assistant Professor, Department of Surgery, University of South Carolina School of Medicine; Attending Physician / Clinical Instructor, Compliance Officer, Department of Emergency Medicine, Prisma Health Richland Hospital

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, Columbia Medical Society, Society for Academic Emergency Medicine, South Carolina College of Emergency Physicians, South Carolina Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Employed contractor - Chief Editor for Medscape.

Additional Contributors

Andrew C Bushnell, MD, MBA, FACEP Regional Medical Director, TeamHealth

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

Disclosure: Nothing to disclose.

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, American Medical Informatics Association, Medical Association of Georgia

Disclosure: Nothing to disclose.

J Michael Kowalski, DO Attending Physician, Department of Emergency Medicine, Division of Medical Toxicology, Einstein Medical Center

J Michael Kowalski, DO is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, American Osteopathic Association

Disclosure: Nothing to disclose.

Jesse Tran, DO Resident Physician, Department of Emergency Medicine, St Mary Mercy Hospital

Jesse Tran, DO is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Osteopathic Association, American Society of Anesthesiologists, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Kevin M Boehm, DO, MSc, FACOEP, FACEP, FAAEM Director of Osteopathic Medical Education, Program Director, Emergency Medicine Residency Program, St Mary Mercy Livonia Hospital; Clinical Instructor, Department of Emergency Medicine, Kirksville College of Osteopathic Medicine, AT Still University

Kevin M Boehm, DO, MSc, FACOEP, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Osteopathic Association, Michigan College of Emergency Physicians, Michigan Osteopathic Association

Disclosure: Nothing to disclose.

Sections Lymphogranuloma Venereum (LGV) in Emergency Medicine
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Lymphogranuloma Venereum (LGV) in Emergency Medicine Guidelines

World Health Organization (WHO) Guidelines on the Treatment of Lymphogranuloma Venereum

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

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

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