Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
Sex Transm Infect. 2014 Jun;90(4):279-82. doi: 10.1136/sextrans-2013-051427. Epub 2014 Apr 30.
Current lymphogranuloma venereum (LGV) guidelines mainly focus on anorectal infections. Inguinal LGV infections have been rare in the current epidemic among men who have sex with men (MSM), but might require a different approach not yet recommended in current guidelines for the treatment and diagnosis of LGV. We describe 4 inguinal LGV cases. Three MSM developed inguinal LGV infection several weeks after a previous consultation, of which two had received azithromycin after being notified for LGV. Three failed the recommended 21 days doxycycline treatment. These inguinal LGV cases highlight 3 pitfalls in the current standard management of LGV: (1) Urethral chlamydia infections in MSM can be caused by LGV biovars that in contrast to non-LGV biovars require prolonged antibiotic therapy. (2) The recommended one gram azithromycin contact treatment seems insufficient to prevent established infections. (3) Inguinal LGV may require prolonged courses of doxycycline, exceeding the currently advised 21 days regimen.
目前的淋巴肉芽肿性静脉炎（LGV）指南主要侧重于肛门直肠感染。在当前男男性行为者（MSM）中的流行中，腹股沟 LGV 感染较为罕见，但可能需要一种尚未在当前 LGV 治疗和诊断指南中推荐的不同方法。我们描述了 4 例腹股沟 LGV 病例。3 名 MSM 在之前就诊后数周出现腹股沟 LGV 感染，其中 2 名在接到 LGV 通知后接受了阿奇霉素治疗。3 名患者未完成推荐的 21 天多西环素治疗。这些腹股沟 LGV 病例突出了当前 LGV 标准管理中的 3 个缺陷：（1）MSM 中的尿道衣原体感染可能由 LGV 生物变体引起，与非 LGV 生物变体相比，需要延长抗生素治疗。（2）推荐的 1 克阿奇霉素接触治疗似乎不足以预防已建立的感染。（3）腹股沟 LGV 可能需要延长多西环素疗程，超过目前建议的 21 天疗程。
