Lymphogranuloma venereum differential diagnosis: Difference between revisions
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==Differentiating Lymphogranuloma Venereum from Other Diseases== | ==Differentiating Lymphogranuloma Venereum from Other Diseases== | ||
Lymphogranuloma venereum (LGV) must be differentiated from other diseases that cause genital ulcers, [[lymphadenopathy]], or [[proctocolitis]] including:<ref name="pmid12081191">{{cite journal| author=Mabey D, Peeling RW| title=Lymphogranuloma venereum. | journal=Sex Transm Infect | year= 2002 | volume= 78 | issue= 2 | pages= 90-2 | pmid=12081191 | doi= | pmc=PMC1744436 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12081191 }} </ref> | |||
*[[Syphilis]] | |||
*[[Herpes simplex]] | |||
*[[Behçet's disease]] | |||
*[[Chancroid]] | |||
*[[Donovanosis]] | |||
*[[Fixed drug eruption]] | |||
*[[Psoriasis]] | |||
*Chlamydial diseases caused by ''C. trachomatis'' [[serovars]] D-K | |||
*[[Colitis]] | |||
[[Sexually transmitted diseases]] characterized as [[genital ulcer diseases]] may present with similar manifestations and lesion characteristics. A diagnosis based only on the patient’s medical history and physical examination frequently is inaccurate. Patients who have genital, anal, or perianal ulcers should be evaluated with laboratory tests to make a definitive diagnosis.<ref name="GUDCDC">2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (June 4, 2015). http://www.cdc.gov/std/tg2015/genital-ulcers.htm Accessed February 18, 2016.</ref> | |||
{| style="font-size: 90%;" | |||
! style="background: #4479BA; padding: 5px 5px;" rowspan="2" | {{fontcolor|#FFFFFF|Clinical Characteristic}} | |||
! style="background: #4479BA; padding: 5px 5px;" colspan="5" | {{fontcolor|#FFFFFF|Sexually Transmitted Disease}} | |||
|- | |||
! style="background: #4479BA; padding: 5px 5px; width: 200px;" | {{fontcolor|#FFFFFF|Chancroid}} | |||
! style="background: #4479BA; padding: 5px 5px; width: 200px;" | {{fontcolor|#FFFFFF|Genital Herpes}} | |||
! style="background: #4479BA; padding: 5px 5px; width: 200px;" | {{fontcolor|#FFFFFF|Donovanosis}} | |||
! style="background: #4479BA; padding: 5px 5px; width: 200px;" | {{fontcolor|#FFFFFF|LGV}} | |||
! style="background: #4479BA; padding: 5px 5px; width: 200px;" | {{fontcolor|#FFFFFF|Syphilis}} | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" | '''Cause''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" | ''[[Haemophilus ducreyi]]'' | |||
| style="padding: 5px 5px; background: #F5F5F5;" | [[Herpes Simplex Virus]] (HSV-1 & HSV-2) | |||
| style="padding: 5px 5px; background: #F5F5F5;" | ''[[Klebsiella|Klebsiella granulomatis]]'' | |||
| style="padding: 5px 5px; background: #F5F5F5;" | ''[[Chlamydia trachomatis]]'' serovars L1, L2, or L3 | |||
| style="padding: 5px 5px; background: #F5F5F5;" | ''[[Treponema pallidum]]'' | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" | '''Lesion Type''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" | [[Papule]] evolving to ulcer | |||
| style="padding: 5px 5px; background: #F5F5F5;" | [[Vesicle]] evolving to [[ulcer]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Ulcer progressing to [[granuloma]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Self-limited papule or ulcer | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Papule evolving to ulcer | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" | '''Lesion Border''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Crater with irregular, sharp margins | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Circular, sharp margins on erythematous base | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Friable base with sharp, raised, rolled margin | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Shallow, smooth border | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Crater with raised edges, smooth margins | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" | '''Lesion Distribution''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Single or multiple | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Multiple, in group/crop | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Single or multiple | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Single or herpetiform | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Multiple | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" | '''Lesion Texture''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Soft | |||
| style="padding: 5px 5px; background: #F5F5F5;" | [[Umbilicated lesions|Umbilicated]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Granulomatous | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Firm bump | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Indurated | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" | '''Lesion Tenderness''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Present | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Present | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Absent | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" | '''Lesion Exudate''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Grey/yellow purulent exudate | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Non-exudative | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Non-exudative but bleeds easily | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Non-exudative | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Non-exudative; non-fluctuant | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" | '''Lymphadenopathy''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Present and tender in approx. half of patients (typically unilateral) | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Present and tender | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Absent from primary infection; pseudobuboes may occur | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Present and tender | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Present and non-tender (uni- or bilateral) | |||
|} | |||
==References== | ==References== | ||
Revision as of 14:38, 18 February 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nate Michalak, B.A.
Overview
Differentiating Lymphogranuloma Venereum from Other Diseases
Lymphogranuloma venereum (LGV) must be differentiated from other diseases that cause genital ulcers, lymphadenopathy, or proctocolitis including:[1]
- Syphilis
- Herpes simplex
- Behçet's disease
- Chancroid
- Donovanosis
- Fixed drug eruption
- Psoriasis
- Chlamydial diseases caused by C. trachomatis serovars D-K
- Colitis
Sexually transmitted diseases characterized as genital ulcer diseases may present with similar manifestations and lesion characteristics. A diagnosis based only on the patient’s medical history and physical examination frequently is inaccurate. Patients who have genital, anal, or perianal ulcers should be evaluated with laboratory tests to make a definitive diagnosis.[2]
| Clinical Characteristic | Sexually Transmitted Disease | ||||
|---|---|---|---|---|---|
| Chancroid | Genital Herpes | Donovanosis | LGV | Syphilis | |
| Cause | Haemophilus ducreyi | Herpes Simplex Virus (HSV-1 & HSV-2) | Klebsiella granulomatis | Chlamydia trachomatis serovars L1, L2, or L3 | Treponema pallidum |
| Lesion Type | Papule evolving to ulcer | Vesicle evolving to ulcer | Ulcer progressing to granuloma | Self-limited papule or ulcer | Papule evolving to ulcer |
| Lesion Border | Crater with irregular, sharp margins | Circular, sharp margins on erythematous base | Friable base with sharp, raised, rolled margin | Shallow, smooth border | Crater with raised edges, smooth margins |
| Lesion Distribution | Single or multiple | Multiple, in group/crop | Single or multiple | Single or herpetiform | Multiple |
| Lesion Texture | Soft | Umbilicated | Granulomatous | Firm bump | Indurated |
| Lesion Tenderness | Present | Present | Absent | Absent | Absent |
| Lesion Exudate | Grey/yellow purulent exudate | Non-exudative | Non-exudative but bleeds easily | Non-exudative | Non-exudative; non-fluctuant |
| Lymphadenopathy | Present and tender in approx. half of patients (typically unilateral) | Present and tender | Absent from primary infection; pseudobuboes may occur | Present and tender | Present and non-tender (uni- or bilateral) |
References
- ↑ Mabey D, Peeling RW (2002). "Lymphogranuloma venereum". Sex Transm Infect. 78 (2): 90–2. PMC 1744436. PMID 12081191.
- ↑ 2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (June 4, 2015). http://www.cdc.gov/std/tg2015/genital-ulcers.htm Accessed February 18, 2016.