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 21 days of doxycycline, but recent evidence suggests shorter antibiotic duration is as effective. We evaluated clinical outcomes in a cohort with LGV treated with 7 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 7 days of doxycycline and anonymized data were collected from electronic patient records. Results Fifty-two individuals with detected LGV-specific DNA were treated with 7 days of doxycycline 100 mg twice daily. All were GBMSM, median age of 35 years (range, 21–64 years), 21 (40%) were living with HIV, and 18 (35%) had concomitant sexually transmitted infections. Thirty-four (65%) were asymptomatic, whereas 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). Chlamydia 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 7-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.