Effective treatment of lymphogranuloma venereum with a seven-day course of doxycycline.

BACKGROUND: Lymphogranuloma venereum (LGV) remains endemic in the United Kingdom, primarily among gay, bisexual or other men who have sex with men (GBMSM). Current treatment guidelines recommend twenty-one days of doxycycline, but recent evidence suggests shorter antibiotic duration is as effective. We evaluated clinical outcomes in a cohort with LGV treated with seven days of doxycycline.

METHODS: We reviewed case notes of all LGV cases at a South London sexual health service between November 2016 and September 2022, treated with only seven days of doxycycline and anonymised data were collected from electronic patient records.

RESULTS: Fifty-two individuals with detected LGV-specific DNA were treated with seven days of doxycycline 100 mg twice daily. All were GBMSM, median age 35 years (range 21-64); 21 (40%) were living with HIV; and 18 (35%) had concomitant sexually transmitted infections.Thirty-four (65%) were asymptomatic, while 18 (35%) reported symptoms: 7 (13%) urethral, 11 (21%) anorectal, and 2 (4%) other symptoms.Twenty-two (42%) were prescribed additional antimicrobials, however none were active against Chlamydia trachomatis.All 52 underwent follow-up testing (range 4 - 481 days); C. trachomatis was detected in one individual, but negative for LGV-specific DNA, and so considered to be a reinfection. All other cases were C. trachomatis negative, indicating successful LGV eradication.

CONCLUSIONS: Our data support the approach of offering a seven-day doxycycline course routinely for asymptomatic or clinically mild C. trachomatis infections, and contacts of LGV infection, regardless of their LGV status. This may simplify patient management, reduce cost and improve antimicrobial stewardship.