Orolabial Lymphogranuloma Venereum, Michigan, USA

Lymphogranuloma venereum of the neck in a young man living with HIV: a rare extragenital presentation

Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by an invasive form of Chlamydia trachomatis, typically affecting the anogenital area with regional lymphatic involvement. Extragenital manifestations are rare but can occur, particularly if the bacterium is inoculated out of the genital tract. To our knowledge, only 13 cases of symptomatic neck LGV have been published so far in the medical literature. We describe a case of a young man living with HIV with bilateral, rapid-growing and painful neck swelling, whose definite diagnosis was challenging. The patient underwent extensive investigation, including repeated ultrasound-guided fine-needle aspirations, microbiological exams and histological characterisation. Genotyping revealed C. trachomatis L2 serovar, confirming LGV as a final diagnosis, affecting neck lymph nodes. Treatment with doxycycline combined with surgical drainage led to clinical resolution. This case emphasises the importance of a comprehensive testing strategy to identify LGV, especially in individuals reporting unprotected oral sex, with unexplained neck lymphadenitis.

Sexually Transmitted Infections Treatment Guidelines, 2021

These guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11–14, 2019. The information in this report updates the 2015 guidelines. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus. Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs.