Patient selection: male who has sex with males with chlamydia isolated from anorectal specimen
Criteria for treating the patient for anorectal LGV:
(1) identification of LGV on serovar typing (definitive diagnosis)
(2) one or more of the following (presumptive diagnosis):
(2a) proctitis by proctoscopic exam (red and swollen mucosa that bleeds easily; mucopurulent discharge)
(2b) >= 11 white blood cells per high power field on anorectal smear (especially if > 50 per hpf)
(2c) HIV positive
The patient may also have an anorectal ulcer and/or enlarged inguinal lymph nodes.
The main difference for a patient with LGV is longer therapy with doxycycline. A patient with non-LGV chlamydia is treated for 7 days versus 21 days for LGV.
Performance:
• The presumptive criteria had an area under the ROC curve of 0.71, which improved if more than one finding was present.
• The performance is affected by prevalence of LGV in the population.
