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Case report
Pitfalls in the diagnosis and management of inguinal lymphogranuloma venereum: important lessons from a case series
  1. Emerentiana Veronica Oud1,
  2. Nynke Hesselina Neeltje de Vrieze2,
  3. Arjan de Meij3,
  4. Henry John C de Vries1,4,5
  1. 1Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  2. 2Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
  3. 3General Practitioners Office Heijnen & de Meij, Amsterdam, The Netherlands
  4. 4The Netherlands STI Outpatient Clinic, Public Health Service Amsterdam, Amsterdam, The Netherlands
  5. 5Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Professor Henry John C de Vries, STI Outpatient Clinic, Cluster of Infectious Diseases, Public Health Service Amsterdam, Amsterdam 1000 CE, The Netherlands; h.j.devries{at}amc.uva.nl

Abstract

Current lymphogranuloma venereum (LGV) guidelines mainly focus on anorectal infections. Inguinal LGV infections have been rare in the current epidemic among men who have sex with men (MSM), but might require a different approach not yet recommended in current guidelines for the treatment and diagnosis of LGV. We describe 4 inguinal LGV cases. Three MSM developed inguinal LGV infection several weeks after a previous consultation, of which two had received azithromycin after being notified for LGV. Three failed the recommended 21 days doxycycline treatment. These inguinal LGV cases highlight 3 pitfalls in the current standard management of LGV: 1) Urethral chlamydia infections in MSM can be caused by LGV biovars that in contrast to non-LGV biovars require prolonged antibiotic therapy. 2) The recommended one gram azithromycin contact treatment seems insufficient to prevent established infections. 3) Inguinal LGV may require prolonged courses of doxycycline, exceeding the currently advised 21 days regimen.

Keywords
  • Men who have sex with men
  • Lymphogranuloma venereum
  • Sexually transmitted infection
  • Human immunodeficiency virus

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