Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2
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Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2
Lymphogranuloma VenereumChristophers. Hall, MD, MS; EÔỐENTIALỐ OF DIAGNOSIS I•In North America, lymphogranuloma venereum typically presents as a proct Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2titis syndrome; elsewhere, genital ulcer disease followed by inguinal lymphadenopathy with or without bubo formation may predominate.•Diagnostic tests include culture and typing for Chlamydia trachomatis and molecular assays.•Patients should be asked about gender of sex partners and travel to areas Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2of endemic disease or outbreaks, and behavioral risk assessment should be performed to elicit risks for transmission.•In patients with suspected infecEbook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2
tion, screening for other STDs, including HIV, is warranted.General ConsiderationsLymphogranuloma venereum (LGV) is a systemic sexually transmitted diLymphogranuloma VenereumChristophers. Hall, MD, MS; EÔỐENTIALỐ OF DIAGNOSIS I•In North America, lymphogranuloma venereum typically presents as a proct Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2 of which are characterized by papules or ulcers with inguinal lymphadenopathy, followed by proctitis (sec Table 17-1). Although LGV is classically an invasive, inflammatory infection, patients may present without significant lymphadenopathy or with mild symptoms. Asymptomatic infection also has bee Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2n observed.LGV is endemic in some regions (Africa, Southeast Asia, Central and South America, and Caribbean countries) while occurring sporadically inEbook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2
others. It remains infrequent in the United States. 1 lowever, case clusters have been reported in the northern hemisphere since 2002. Notably, an ouLymphogranuloma VenereumChristophers. Hall, MD, MS; EÔỐENTIALỐ OF DIAGNOSIS I•In North America, lymphogranuloma venereum typically presents as a proct Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2usters have been reported in Belgium, France,108Sweden, and Canada, with fewer than two dozen confirmed cases reported throughout the United States by 2005.Recent outbreaks and case clusters demonstrate the need for heightened awareness of this STD in the United States. LGV should be considered in t Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2hose at risk for S IDs, especially MSM and others reporting unprotected receptive anal intercourse who present with rectal complaints or lymphadenopatEbook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2
hy. Such patients, along with any patient with a compatible clinical presentation, should be asked about travel to areas of endemic disease or outbreaLymphogranuloma VenereumChristophers. Hall, MD, MS; EÔỐENTIALỐ OF DIAGNOSIS I•In North America, lymphogranuloma venereum typically presents as a proct Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2e higher.In the United States, poorly standardized serologic tests lacking specificity- and limited availability of tissue culture and molecular tests for rectal evaluation complicate both diagnosis and measurement of the true incidence of LGV. Although the incidence of fulminant LGV has dramaticall Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2y decreased in industrialized countries since the advent of antibiotics, ar least one researcher has suggested a low but persistent cndemicity of LGVEbook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2
among those at risk for rectal chlamydial infection, particularly MSM.Schachter J. MoncjilaJ. I .yrnphogranulonia venereum: How to turn an endemic disLymphogranuloma VenereumChristophers. Hall, MD, MS; EÔỐENTIALỐ OF DIAGNOSIS I•In North America, lymphogranuloma venereum typically presents as a proct Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2 men in San Francisco since the 1980s and suj>ỹ.estinp. that recent casefinding, rather than transmission, may be contributing to the increased prevalence.)Pathogenesisc trachomatis is an obligate intracellular microorganism that is dependent on the host cell for Al'P production and replication. The Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2 organism is surrounded by an outer membrane mainly composed of a major outer membrane protein (MOMP). Eighteen serovars of c trachomatis are classifiEbook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2
ed according to the Omp I gene encoding MOMp. The trachoma biovar includes serovars A through K andCopyright © 2007 by The McGraw-Hill Companies. Inc.Lymphogranuloma VenereumChristophers. Hall, MD, MS; EÔỐENTIALỐ OF DIAGNOSIS I•In North America, lymphogranuloma venereum typically presents as a proct Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2nent HistorySymptomsLymphadenopathy syndrome Primary stageIncubation 3-30 d•Typically small, painless genital papule with or without urethritis or cervicitis that may ulcerate •Usually unrecognized by patient and resolves without treatmentSecondary stageOccurs 2 6 wk after primary stage•One or more Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2regional lymph nodes that may ulcerate (ie, bubo); inguinal or femoral nodes may cause‘groove" sign •One third of buboes may rupture •Genital ulcers mEbook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2
ay be manifest concurrently with lymphadenitisProctitis and proctocolitisRisk factors include anal intercourse or other anal penetration•Rectal dischaLymphogranuloma VenereumChristophers. Hall, MD, MS; EÔỐENTIALỐ OF DIAGNOSIS I•In North America, lymphogranuloma venereum typically presents as a proct Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2toms (ie, weight loss, fatigue) may bo presentis responsible lor infections involving mucosa of die genital tract and the eye. Serovars ĩ.ĩ, 1.2 (ĩ.2a/ĩ.2b), and Ĩ.3 comprise the Ĩ.GV biovar, which is more invasive, involving proliferation in lymphoid tissues.PreventionPrevention of LGV requires a m Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2ultipronged strategy of promoting risk reduction among those likeliest to contract the infection, treating those diagnosed as well as those at high riEbook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2
sk with a compatible clinical syndrome, and identifying and presumptively treating exposed sex partners who may have been infected.Providers should asLymphogranuloma VenereumChristophers. Hall, MD, MS; EÔỐENTIALỐ OF DIAGNOSIS I•In North America, lymphogranuloma venereum typically presents as a proct Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2sk factor identified for transmission of LGV is unprotected receptive anal intercourse or other penetration (eg, “fisting ), highlighting the importance of providers asking about such practices in routine, periodic sexual risk assessments. Tools to assist providers with risk assessment are available Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2 from the California STD/111V Prevention Training Center (http://unviv.sti(ihivtrain-ing. ortfpdflask-screen -intervene).I HV-infected MSM have been mEbook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2
ost often affected in recent outbreaks of LGV proctitis in Europe. For instance, in the well-characterized Netherlands outbreak in 2003-2004, 92 confiLymphogranuloma VenereumChristophers. Hall, MD, MS; EÔỐENTIALỐ OF DIAGNOSIS I•In North America, lymphogranuloma venereum typically presents as a proct Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2e HIV-positive. Most patients presented with lower gastrointestinal symptoms, including mucopurulent sometimes bloody anal discharge and other symptoms of proctitis. Only one patient had a genital ulcer or bubo. Six of 13 patients with concurrent STDs had gonorrhea, herpes simplex virus (HSV), syphi Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2lis, or chronic hepatitis B. In all cases, LGV was associated with scrum antibodies to c trachomatis and rectal C’ trachomatis isolates of the L1-L3 sEbook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2
erovar subtype, but chlamydial DNA was not found in urethral specimens, such that this common diagnostic approach would not have led to recognition ofLymphogranuloma VenereumChristophers. Hall, MD, MS; EÔỐENTIALỐ OF DIAGNOSIS I•In North America, lymphogranuloma venereum typically presents as a proct Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2 recent acquisition of hepatitis c infection in 5 others.Other European case clusters in 2004-2005 were observed in Paris, Antwerp, Hamburg, and elsewhere, including the United Kingdom. Similarly, all patients were MSM, and more than half were 1 llV-positive.These case dusters and reports have demon Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2strated the significance of local sexual networks in transmission of this STD while highlighting the barriers to accurate diagnosis of rectal infectioEbook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2
ns, including LGV. The potential facilitation of HIV acquisition and transmission in the setting of an inflammatory rectal infection has heightened coLymphogranuloma VenereumChristophers. Hall, MD, MS; EÔỐENTIALỐ OF DIAGNOSIS I•In North America, lymphogranuloma venereum typically presents as a proct Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2ion of incipient LGV clusters difficult.HO / CHAPTER 17Following the northern hemisphere eases of LGV, the US Centers for Disease Control and Prevention (CDC) established a targeted surveillance effort to identify incident cases in the United States and to advise clinicians on appropriate diagnosis Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2and treatment of LGV {bttpdlwww.cdc.govlstdllgv}. By 2005, fewer than two dozen cases had been identified in the United States, and case clusters drivEbook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2
en by sexual networks and international travel had not been identified.A.Significance of Rectal Infections________________Notwithstanding the limited Lymphogranuloma VenereumChristophers. Hall, MD, MS; EÔỐENTIALỐ OF DIAGNOSIS I•In North America, lymphogranuloma venereum typically presents as a proct Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2V-uninfcctcd individual should be considered a sentinel event with respect to elevated risk of 111V acquisition. Such a diagnosis necessitates education, ongoing risk assessment and risk reduction counseling, and screening for other SIDs and 111V, with follow-up screening 3 months after diagnosis. Ebook Current diagnosis amp; treatment of sexually transmitted diseases: Part 2Gọi ngay
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