Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

INITIAL

asymptomatic adolescent and adult patients who have been exposed to lymphogranuloma venereum (LGV)

1st line – antibiotics

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INITIAL
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asymptomatic adolescent and adult patients who have been exposed to lymphogranuloma venereum (LGV)
1st line – 

antibiotics

For asymptomatic persons who have had sexual contact with a patient with LGV.

Treatment guidelines for sexual contacts differ by region. Anyone who may have been exposed by contact, either from unprotected sexual intercourse within 60 days to 3 months of the partner's presentation of symptoms, or by direct contact with an LGV lesion or discharge from a lymph node or the rectum, should be contacted for assessment, counseling, and postexposure prophylaxis or antibiotic treatment.[1][30]

The CDC recommends a 7-day course of doxycycline.[30] European guidelines do not recommend a course shorter than 3 weeks.[1]

Primary options

doxycycline: 100 mg orally twice daily for 7-21 days

ACUTE

all stages of lymphogranuloma venereum (LGV)

1st line – antibiotics

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ACUTE
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all stages of lymphogranuloma venereum (LGV)
1st line – 

antibiotics

Doxycycline is the recommended first-line treatment.

Doxycycline is contraindicated in patients with allergies to tetracyclines and women who are pregnant or lactating. Macrolides are an acceptable alternative in these patients. Expert opinion suggests that macrolides, given their effectiveness against other chlamydial genovars/serovars, are effective treatments for LGV.[44]

If disease is still present after 3 weeks of therapy, alternative diagnoses should be ruled out. Prolonging or broadening the spectrum of antibiotics, therefore, may be necessary for other infections or bacterial superinfection.

Primary options

doxycycline: 100 mg orally twice daily for 21 days

Secondary options

azithromycin: 1 g orally once weekly for 3 weeks

OR

erythromycin base: 500 mg orally four times daily for 21 days

Consider – aspiration of pus

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ACUTE
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all stages of lymphogranuloma venereum (LGV)
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patients with secondary lymphogranuloma venereum (LGV)
Consider – 

aspiration of pus

Treatment recommended for SOME patients in selected patient group

Advanced disease may require surgical evaluation.

Pus should be aspirated from bubonuli using a lateral approach through normal skin as a measure to prevent rupture and formation of sinus tracts.

Incision and drainage or surgical excision is avoided where possible as these procedures may impair lymphatic drainage, lead to formation of sinus tracts, and complicate healing.[1][22][48]

Consider – surgical reconstruction

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ACUTE
|
all stages of lymphogranuloma venereum (LGV)
|
patients with tertiary lymphogranuloma venereum (LGV)
Consider – 

surgical reconstruction

Treatment recommended for SOME patients in selected patient group

Disfiguration of the genitalia associated with esthiomene or elephantiasis may not resolve with standard antibiotic treatment for LGV alone. Plastic surgical reconstruction is considered several months after antibiotic treatment is completed and there is evidence that there has been resolution of active disease.[1][22][48]

Advanced anorectal disease may require surgical evaluation as rectal strictures do not resolve with standard antibiotic treatment for LGV alone. Indications for surgical intervention include stricture formation, bowel obstruction, rectovaginal fistula, and gross destruction of the anal canal, anal sphincter, and perineum.[1][48]

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Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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