What is new in this updated guideline?This is the update version of the 2010 European guideline on the management of lymphogranuloma venereum (LGV).
New issues are:Epidemiology 1 Based on clonal relatedness of prevalent LGV strains there is evidence that the LGV epidemic among men who have sex with men (MSM) in the Western world prevailed already in the United States in the 1980s and was introduced into Europe by the end of the last century.
Aetiology and transmission1 A new LGV variant causing severe proctitis was unveiled and designated L2c. 2 The L2b LGV variant causing the vast majority of infections among MSM is now also found among a few heterosexual women.
Management1 Apart from HIV and STI screening, Hepatitis C Virus (HCV) testing should be offered to all LGV patients. 2 To exclude reinfections, STI screening during a follow-up visit 3 months after an LGV diagnosis should be offered.
Conflicts of interestNone declared.
Funding sourcesNone declared.
Lymphogranuloma venereum (LGV)
EpidemiologyThe LGV has re-emerged among European men who have sex with men (MSM) in the past decade 1 and is probably endemic in this population where it is a relatively common cause of proctitis and occasional genital ulcer-adenopathy disease.LGV among MSM in Europe is caused in the majority of cases by the Chlamydia trachomatis biovar L2b which shows a high degree of clonal relatedness as found by Multi Locus Sequence Typing in a
Proctitis is defined as an inflammatory syndrome of the distal 10-12 cm of the anal canal, also called the rectum. Infectious proctitis can be sexually transmitted via genital-anal mucosal contact, but some also via mutual masturbation.N. gonorrhoeae,C. trachomatis(including lymphogranuloma venereum), Herpes Simplex Virus andT. pallidumare the most common sexually transmitted anorectal pathogens. Shigellosis can be transferred via oral-anal contact and may lead to proctocolitis or enteritis. Although most studies on these infections have concentrated on men who have sex with men (MSM), a significant proportion of women have anal intercourse and therefore may also be at risk. A presumptive clinical diagnosis of proctitis can be made when there are symptoms and signs, and a definitive diagnosis when the results of laboratory tests are available. The symptoms of proctitis include anorectal itching, pain, cramps (tenesmus) and discharge in and around the anal canal. Asymptomatic proctitis occurs frequently and can only be detected by laboratory tests. The majority of rectal chlamydia and gonococcal infections are asymptomatic. Therefore when there is a history of receptive anal contact, exclusion of anorectal infections is generally indicated as part of standard screening for sexually transmitted infections (STIs). Condom use does not guarantee protection from bacterial and protozoan STIs, which are often spread without penile penetration.
Erosive lichen planus is characterized by painful, multi-focal erythematous-ulcerative areas affecting mucosal oral and genital areas. Topical therapies are usually ineffective, whereas systemic steroids and immunosuppressive agents are frequently associated with a wide spectrum of side effects. Herein, we presented our positive experience in the treatment of a case of multi-resistant erosive lichen planus with extracorporeal photochemotherapy.
Erosive lichen planus is characterized by painful, multi-focal erythematous-ulcerative areas affecting mucosal oral and genital areas. Topical therapies are usually ineffective, whereas systemic steroids and immunosuppressive agents are frequently associated with a wide spectrum of side effects. Herein, we presented our positive experience in the treatment of a case of multi-resistant erosive lichen planus with extracorporeal photochemotherapy.
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