Guidelines for the Management of Sexually Transmitted Infections: 3. TREATMENT OF SPECIFIC INFECTIONS: 3.3. Lymphogranuloma venereum

Guidelines for the Management of Sexually Transmitted Infections
(2001; 88 pages)

Table of Contents

PREFACE
1. INTRODUCTION
	1.1. Background
	1.2. Rationale for standardized treatment recommendations
	1.3. Case management
	1.4. Syndromic management
	1.5. Risk factors for STI-related cervicitis
	1.6. Selection of drugs
2. TREATMENT OF STI-ASSOCIATED SYNDROMES
	2.1. Urethral discharge
		2.1.1. Persistent or recurrent urethral discharge
	2.2. Genital ulcer
		Genital ulcer and HIV infection
		Inguinal bubo
	2.3. Scrotal swelling
	2.4. Vaginal discharge
		Cervical infection
		Vaginal infection
	2.5. Lower abdominal pain
	2.6. Neonatal conjunctivitis
3. TREATMENT OF SPECIFIC INFECTIONS
	3.1. Gonococcal infections
		Uncomplicated anogenital infection
		Disseminated infection
		Gonococcal ophthalmia
	3.2. Chlamydia trachomatis infections (other than lymphogranuloma venereum)
		Uncomplicated anogenital, endocervical or rectal infections
		Neonatal chlamydial conjunctivitis
		Infantile pneumonia
	3.3. Lymphogranuloma venereum
	3.4. Syphilis
		Early syphilis
		Late latent syphilis
		Neurosyphilis
		Syphilis and HIV infection
		Syphilis in pregnancy
		Congenital syphilis
	3.5. Chancroid
	3.6. Granuloma inguinale (Donovanosis)
	3.7. Genital herpes infections
		First clinical episode
		Recurrent infections
		Suppressive therapy
		Herpes in pregnancy
		Herpes and HIV co-infection
	3.8. Venereal warts
		Vaginal warts
		Cervical warts
		Meatal and urethral warts
	3.9. Trichomonas vaginalis infections
	3.10. Bacterial vaginosis
		Bacterial vaginosis in pregnancy
	3.11. Candidiasis
		Vulvovaginal candidiasis
		Vulvovaginal candidiasis in pregnancy
		Vulvovaginal candidiasis and HIV infection
		Balanoposthitis
	3.12. Scabies
	3.13. Phthiriasis (pediculosis pubis)
4. KEY CONSIDERATIONS UNDERLYING TREATMENTS
	4.1. The choice of antimicrobial regimens
	4.2. Comments on individual drugs
	4.3. Antimicrobial resistance in N. gonorrhoeae
	4.4. Antimicrobial resistance in H. ducreyi
5. PRACTICAL CONSIDERATIONS IN STI CASE MANAGEMENT
	5.1. The Public Health package for STI prevention and care
	5.2. Clinical considerations
	5.3. Education for primary prevention
	5.4. Education and counselling during an STI consultation
	5.5. Notification and management of sexual partners
	5.6. Access to services
6. CHILDREN⁶, ADOLESCENTS AND SEXUALLY TRANSMITTED INFECTIONS
	6.1. Evaluation for sexually transmitted infections
ANNEX. LIST OF PARTICIPANTS

3.3. Lymphogranuloma venereum

Results of controlled trials on the treatment of lymphogranuloma venereum have not been published, and recommendations are based on expert opinion.

Recommended regimen

• doxycycline, 100mg orally, twice daily for 14 days

OR

• erythromycin, 500mg orally, 4 times daily for 14 days.

Alternative regimens

• tetracycline, 500mg orally, 4 times daily for 14 days

Note

• Tetracyclines are contraindicated in pregnancy.

• Fluctuant lymph nodes should be aspirated through healthy skin. Incision and drainage or excision of nodes may delay healing. Some patients with advanced disease may require treatment for longer than 14 days, and sequelae such as strictures and/or fistulae may require surgery.