MAUI, HAWAII — Lymphogranuloma venereum is making a comeback, and this time around the STD looks nothing like it did during residency training.
The new clinical picture of lymphogranuloma venereum (LGV) is proctitis in slightly older gay men, Dr. Theodore Rosen explained at the annual Hawaii dermatology seminar sponsored by Skin Disease Education Foundation.
In developed countries, “the resurgence is virtually all in men who have sex with men, more than 35 years old, white, sometimes coinfected with HIV or hepatitis C. It presents as proctitis, which could be anything from a mild anorectal discharge, pain, bloody stools, to a feeling of incomplete evacuation. And we've now seen two cases that presented with severe rectal itching and that's all,” said Dr. Rosen, professor of dermatology at Baylor College of Medicine, Houston.
The classic form involves infection of the inguinal lymphatics and lymph nodes, resulting in buboes that can make walking difficult. This form has always been rare in industrialized countries; even in underdeveloped tropical countries where it's endemic it accounts for less than 10% of cases of genital ulcer disease, he noted.
Dr. Rosen urged physicians to consider LGV as a possibility in patients who present with proctitis and fall within the appropriate demographic group. The diagnosis is established by obtaining a rectal swab and sending it to the Centers for Disease Control and Prevention. The treatment for LGV is doxycycline at 100 mg b.i.d. for 21 days. Minocycline is an effective alternative, he added.
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