Treatment of lymphogranuloma venereum

Lymphogranuloma venereum (LGV) classically presents with 1 or more genital ulcers or papules, as well as inguinal lymphadenopathy (buboes). Recently reported cases of LGV proctitis in men who have sex with men, many of whom are coinfected with human immunodeficiency virus (HIV), have highlighted the importance of optimal clinical treatment of LGV.

A review was conducted of the literature on LGV published between 1998 and 2004, as part of the development of the 2006 sexually transmitted disease treatment guidelines of the Centers for Disease Control and Prevention (CDC).

Doxycycline (100 mg orally twice daily for 21 days) remains the treatment of choice for LGV. No controlled trials support the use of azithromycin or the use of alternative treatment regimens for persons with HIV infection.

On the basis of the present literature review, the CDC's treatment recommendations for LGV remain unchanged. LGV clinical care, surveillance, and research are severely hindered by the lack of widely available, rapid, standardized tests for the diagnosis of LGV; therefore, patients with symptoms suggestive of LGV, including LGV proctitis, should be presumptively treated with antibacterial therapy for 3 weeks.