Lymphogranuloma venereum medical therapy: Difference between revisions

Jump to navigation Jump to search
Line 7: Line 7:


==Medical Therapy==
==Medical Therapy==
===Antimicrobial Regimen===


{| style="background: #FFFFFF;"
:*'''Lymphogranuloma venereum (LGV) treatment'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
| valign=top |
::* Preferred regimen: [[Doxycycline]] 100 mg PO bid for 21 days
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
::* Alternative regimen: [[ Erythromycin]] base 500 mg PO qid for 21 days
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Lymphogranuloma Venereum, Chlamydia Trachomatis Infection Treatment}}
::* Note (1): [[Azithromycin]] 1 g PO once weekly for 3 weeks is probably effective based on its chlamydial antimicrobial activity. Fluoroquinolone-based treatments might also be effective, but extended treatment intervals are likely required.
|-
::* Note (2): Pregnant and lactating women should be treated with [[Erythromycin]]. [[Azithromycin]] might prove useful for treatment of LGV in pregnancy, but no published data are available regarding its safety and efficacy. [[Doxycycline]] is contraindicated in pregnant women.
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | Preferred Regimen
::* Note (3): Persons with both LGV and HIV infection should receive the same regimens as those who are HIV negative. Prolonged therapy might be required, and delay in resolution of symptoms might occur.
|-
::* Note (4): Persons who have had sexual contact with a patient who has LGV within the 60 days before onset of the patient’s symptoms should be examined and tested for urethral, cervical, or rectal chlamydial infection depending on anatomic site of exposure. They should be presumptively treated with a chlamydia regimen ( [[Azithromycin]] 1 g PO single dose {{or}} [[Doxycycline]] 100 mg PO bid for 7 days).
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Doxycycline]] 100 mg po bid x 21 days'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | Alternative Regimen
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Erythromycin]] 500 mg po qid x 21 days'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | OR
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Azithromycin]] 1 gm po qWeek x 3 weeks'''''
|-
|}
|}
===Acute Pharmacotherapy===
Treatment involves antibiotics and may involve drainage of the buboes or [[abscess]]es by needle [[aspiration]] or [[incision]]. Further supportive measure may need to be taken:  dilatation of the rectal [[stricture]], repair of [[rectovaginal fistula]]e, or [[colostomy]] for rectal obstruction.  
Common antibiotic treatments include: [[tetracycline]], [[doxycycline]] (all tetracyclines, including doxycycline, are contraindicated during pregnancy and in children due to effects on bone development and tooth discoloration), and [[erythromycin]].
 
If a patient has been treated for LGV, he/she should notify any sex partners they had sex with within 60 days of the symptom onset so they can be evaluated and treated. This will reduce the risk that their partners will develop symptoms and/or serious complications of LGV.  It will reducetheir  risk of becoming re-infected as well as reduce the risk of ongoing [[transmission]] in the community. The patient and all of his/her sex partners should avoid sex until the patient has completed treatment for the infection and symptoms of both the patient and their partners have disappeared.
 
Note: Doxycycline is not recommended for use in [[pregnant]] women. Pregnant and lactating women should be treated with erythromycin. Azythromycin may prove useful for treatment of LGV in pregnancy, but no published data are available regarding its safety and efficacy. A health care provider (like a doctor or nurse) can discuss treatment options with patients.
 
Persons with both LGV and [[HIV]] infection should receive the same LGV treatment as those who are HIV-negative. Prolonged therapy may be required, and delay in resolution of symptoms may occur among persons with HIV.
 
As with all [[Sexually transmitted disease|STD]]'s sex partners of patients who have LGV should be examined and tested for [[urethra]]l or [[cervix|cervical]] [[chlamydia]]l infection. After a positive culture for chlamydia, clinical suspicion should be confirmed with  testing to distinguish serotype.  Antibiotic treatment should be started if they had sexual contact with the patient during the 30 days preceding onset of symptoms in the patient. Patients with a sexually transmitted disease need to be tested for other STD's.  Antibiotics are not without risks and prophylaxtic broad antibiotic coverage is not recommended.<ref name="Workowski-2010">{{Cite journal  | last1 = Workowski | first1 = KA. | last2 = Berman | first2 = S. | last3 = Workowski | first3 = KA. | last4 = Bauer | first4 = H. | last5 = Bachman | first5 = L. | last6 = Burstein | first6 = G. | last7 = Eckert | first7 = L. | last8 = Geisler | first8 = WM. | last9 = Ghanem | first9 = K. | title = Sexually transmitted diseases treatment guidelines, 2010. | journal = MMWR Recomm Rep | volume = 59 | issue = RR-12 | pages = 1-110 | month = Dec | year = 2010 | doi =  | PMID = 21160459 }}</ref>


==References==
==References==

Revision as of 20:22, 11 August 2015

Lymphogranuloma venereum Microchapters

Home

Patient Information

Overview

Historical Perspective

Pathophysiology

Causes

Classification

Differentiating Lymphogranuloma venereum from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Lymphogranuloma venereum medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Lymphogranuloma venereum medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Lymphogranuloma venereum medical therapy

CDC on Lymphogranuloma venereum medical therapy

Lymphogranuloma venereum medical therapy in the news

Blogs on Lymphogranuloma venereum medical therapy

Directions to Hospitals Treating Lymphogranuloma venereum

Risk calculators and risk factors for Lymphogranuloma venereum medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

There is no vaccine against the bacteria. LGV can be treated with three weeks of antibiotics. CDC STD Treatment Guidelines recommend the use of doxycyline, twice a day for 21 days. An alternative treatment is erythromycin base or azithromycin. The health care provider will determine which is best.

Medical Therapy

Antimicrobial Regimen

  • Lymphogranuloma venereum (LGV) treatment[1]
  • Preferred regimen: Doxycycline 100 mg PO bid for 21 days
  • Alternative regimen: Erythromycin base 500 mg PO qid for 21 days
  • Note (1): Azithromycin 1 g PO once weekly for 3 weeks is probably effective based on its chlamydial antimicrobial activity. Fluoroquinolone-based treatments might also be effective, but extended treatment intervals are likely required.
  • Note (2): Pregnant and lactating women should be treated with Erythromycin. Azithromycin might prove useful for treatment of LGV in pregnancy, but no published data are available regarding its safety and efficacy. Doxycycline is contraindicated in pregnant women.
  • Note (3): Persons with both LGV and HIV infection should receive the same regimens as those who are HIV negative. Prolonged therapy might be required, and delay in resolution of symptoms might occur.
  • Note (4): Persons who have had sexual contact with a patient who has LGV within the 60 days before onset of the patient’s symptoms should be examined and tested for urethral, cervical, or rectal chlamydial infection depending on anatomic site of exposure. They should be presumptively treated with a chlamydia regimen ( Azithromycin 1 g PO single dose OR Doxycycline 100 mg PO bid for 7 days).

References

  1. Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.


Template:WikiDoc Sources