Lymphogranuloma Venereum (LGV)

Lymphogranuloma venereum (LGV) is caused by C. trachomatis. The most common clinical manifestation of LGV among heterosexuals is tender inguinal and/or femoral lymphadenopathy that is typically unilateral. A self-limited genital ulcer or papule sometimes occurs at the site of inoculation. However, by the time patients seek care, the lesions have often disappeared. Rectal exposure in women or men who have sex with men (MSM) can result in proctocolitis, including mucoid and/or hemorrhagic rectal discharge, anal pain, constipation, fever, and/or tenesmus. LGV is an invasive, systemic infection, and if it is not treated early, LGV proctocolitis can lead to chronic, colorectal fistulas and strictures. Genital and colorectal LGV lesions can also develop secondary bacterial infection or can be coinfected with other sexually and nonsexually transmitted pathogens.

Genital and lymph node specimens (i.e., lesion swab or bubo aspirate) can be tested for C. Trachomatis.
In the absence of specific LGV diagnostic testing, patients with a clinical syndrome consistent with LGV, including proctocolitis or genital ulcer disease with lymphadenopathy, should be treated for LGV as described in this report.

LGV can be transmitted during vaginal and anal sex.

Early symptoms of LGV infection include a small, painless ulcer on the genitals or anus occurring three to thirty days following exposure. More common symptoms include tender lymph nodes in the groin area that may be swollen and inflamed with genital exposure, and/or rectal bleeding and drainage from the rectum with receptive anal exposure.

Lymph nodes in the groin area can swell and rupture causing permanent scarring and severe pain. Patients with rectal infections can have pain around the anus, drainage from the rectum, and rectal bleeding. If left untreated, infection can lead to rectal scarring and permanent narrowing (stricture) of the rectum.

The diagnosis of LGV is suspected in a person with typical symptoms and in whom other diagnoses, such as chancroid, herpes and syphilis have been excluded. The diagnosis is usually made by a blood test that detects specific antibodies to chlamydia, which are produced as part of the body's immune response to becoming infected with LGV. Additional tests may be available through your doctor.

Treatment cures infection and prevents ongoing tissue damage, although tissue reaction to the infection can result in scarring. Buboes might require aspiration through intact skin or incision and drainage to prevent the formation of inguinal/femoral ulcerations. Doxycycline is the preferred treatment 100 mg orally twice a day for 21 days. If Doxycycline cannot be used, Erythromycin 500 mg orally four times a day for 21 days can be substituted.

Patients should be followed clinically until signs and symptoms have resolved.

Persons who have had sexual contact with a patient who has LGV within the 60 days before onset of the patient’s symptoms should be examined, tested for urethral or cervical chlamydial infection, and treated with a chlamydia regimen (azithromycin 1 gm orally single dose or doxycycline 100 mg orally twice a day for seven days).

Pregnancy Pregnant and lactating women should be treated with erythromycin. Azithromycin might prove useful for treatment of LGV in pregnancy, but no published data are available regarding its safety and efficacy. Doxycycline is contraindicated in pregnant women.

HIV Infection Persons with both LGV and HIV infection should receive the same regimens as those who are HIV negative. Prolonged therapy might be required, and delay in resolution of symptoms might occur.

How can LGV be prevented?

There are a number of ways to prevent or reduce the risk of acquiring or transmitting LGV :

• Practice abstinence. Not having sex is the best protection against LGV and other sexually transmitted diseases.
• Having sex with only one uninfected partner who only has sex with you is safe.
• Limit the number of sex partners.
• Use a male or female condom.
• Carefully wash genitals after sex.
• If you think you are infected, avoid any sexual contact and visit your local STD clinic, hospital or your doctor. Immediately notify all your sexual contacts so they can get examined and treated.

• Illinois Department of Public Health
  IDPH HIV/STD Hotline 800-243-2437 (TTY 800-782-0423)
• U.S. Centers for Disease Control and Prevention (CDC)
  www.cdc.gov/std/ 
  CDC-INFO Hotline (7am-7pm Mon.-Fri. Closed Holidays)
  STD information and referrals to STD Clinics 
  800-CDC-INFO (800-232-4636) 
  TTY: 888-232-6348 
  In English, en Español
• CDC National Prevention Information Network (NPIN) 
  P.O. Box 6003 
  Rockville, MD 20849-6003 
  800-458-5231 
  888-282-7681 Fax 
  E-mail: info@cdcnpin.org
• American Social Health Association (ASHA) 
  P. O. Box 13827 
  Research Triangle Park, NC 27709-3827 
  919-361-8400