Lymphogranuloma venereum laboratory findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nate Michalak, B.A., Aysha Anwar, M.B.B.S[2]
Overview
Because of limitations in commercially available tests, clinical presentation, in conjunction to laboratory findings, plays an important role in diagnosis. C. trachomatis can be identified from lesion swabs, bubo aspirate, or rectal mucosa swabs (in patients with proctitis) using culture methods, serologic testing, and nucleic acid amplification tests (NAATs). Culture is impractical since it is time consuming and lacks sensitivity. Compliment fixation and immunofluorescence serologic tests are sensitive but only genus specific. NAATs are the most reliable method for detecting C. trachomatis and real-time PCR can detect the LGV-specific serovar.
Laboratory Findings
Culture
- Primary lesion swabs or bubo aspirate can be cultured on cyclohexamide-treated McCoy or HeLa cells.
- Sensitivity is approximately 75% - 85%.[1]
- Culture is impractical due to its time-consuming nature, the fact that it's not readily available, and the test yields isolate only 30% of the time.[2]
Serology
- Compliment fixation and immunofluorescence tests of lesion swab or bubo aspirate can be used to detect C. trachomatis.
- Serology is only genus specific.
- Cross-reactivity with other species is possible.[2]
- A complement fixation titer of >1:64 with appropriate clinical presentation is suggestive of LGV.
- An immunofluorescence titer of >1:256 with appropriate clinical presentation is suggestive of LGV.[3]
Nucleic Acid Amplification Tests (NAATs)
- Lesion swabs, bubo aspirate, or rectal mucosa swabs can be tested for C. trachomatis using nucleic acid amplification tests (NAATs).
- NAATs have high specificity and sensitivity for C. trachomatis.[1]
- NAATs performed on rectal specimens are not approved by the FDA but appear more accurate than other testing methods and are the preferred approach.[3][4]
- A biovar-specific polymerase chain reaction (PCR) test has been developed to detect the L-type serovars of LGV C. trachomatis.[1]
Other Laboratory Tests
Persons who receive an LGV diagnosis should be tested for other STDs, especially HIV, gonorrhea, and syphilis.[3]
References
- ↑ 1.0 1.1 1.2 Ceovic R, Gulin SJ (2015). "Lymphogranuloma venereum: diagnostic and treatment challenges". Infect Drug Resist. 8: 39–47. doi:10.2147/IDR.S57540. PMC 4381887. PMID 25870512.
- ↑ 2.0 2.1 Mabey, D (2002). "Lymphogranuloma venereum". Sexually Transmitted Infections. 78 (2): 90–92. doi:10.1136/sti.78.2.90. ISSN 1368-4973.
- ↑ 3.0 3.1 3.2 2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (June 4, 2015). http://www.cdc.gov/std/tg2015/lgv.htm Accessed February 25, 2016.
- ↑ http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/chlamydia-and-gonorrhea-screening Accessed on Sep 8, 2016