Lymphogranuloma venereum Diagnosis and management Initial diagnostic testing Q Does the patient have suspected lymphogranuloma venereum infection? No Consider alternative diagnoses. Yes Obtain an NAAT to detect C. trachomatis nucleic acid in urethral, cervical, urine, rectal, and pharyngeal specimens. Nucleic amplification tests BASHH Q Does NAAT show the presence of C. trachomatis nucleic acid? No Consider alternative diagnoses. Obtain a PCR for LGV DNA in patients with a positive NAAT, in order to confirm the diagnosis. General principles BASHH Q Does PCR confirm lymphogranuloma venereum infection? No Consider alternative diagnoses. Yes Administer antibiotic treatment for at least 3 weeks in patients with LGV to prevent or reduce the chronic complications of the disease. First-line therapy BASHH Q Is doxycycline contra-indicated? No Administer doxycycline (100 mg PO BID, for 21 days) as first-line therapy in patients with LGV. B Yes Second-line regimens BASHH Q Are macrolides contra-indicated? No Consider using erythromycin (500 mg PO QID, for 21 days) second-line therapy for LGV. C Consider using azithromycin (1 g PO once weekly, for 21 days) as second-line therapy for LGV. C Yes Alternative regimens BASHH Q Are tetracyclines other than doxycycline contra-indicated? No Consider using minocycline (300 mg loading dose, followed by 200 mg PO BID, for 21 days) as a third-line option for the treatment of LGV. C Consider using tetracycline (500 mg PO QID, for 21 days) as a third-line option for the treatment of LGV. C Yes Seek expert advice regarding antibiotic choice. General counseling Advise patients that LGV is curable with antibiotics, but can have serious and permanent adverse sequelae if left untreated. Advise patients that symptoms should resolve 1-2 weeks of initiating antibiotic therapy. Advise patients that unprotected sexual intercourse should be avoided until they and their partners have completed treatment and follow-up. 