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Lymphogranuloma Venereum

What is lymphogranuloma venereum?

Lymphogranuloma venereum (LGV) is a sexually transmitted infection (STI) caused by specific strains of the bacteria Chlamydia trachomatis. It is still uncommon in New Zealand, but, following outbreaks of infection amongst men who have sex with men overseas, there has been a recent increase in local cases.

Who is at risk of lymphogranuloma venereum?

Sexually active people may be at risk of getting LGV. LGV is passed from person to person through direct contact with lesions, ulcers or other area where the bacteria is located. Transmission of the organism occurs during sexual penetration (vaginal, oral, or anal) and may also occur via skin-to-skin contact.

What are the signs and symptoms of lymphogranuloma venereum?

Once infected there is an incubation period of anywhere from 3 days to 6 weeks (on average 10-14 days) before any signs or symptoms become apparent. Initial signs, such as small painless genital papules or ulcers, often go unnoticed as they heal quickly or they may be mistaken for other infections such as genital herpes.

Most people seek care weeks later when painful and swollen lymph glands develop around the groin region.

LGV may also produce rectal ulcers, bleeding, pain, and discharge, especially among those who engage in receptive anal intercourse. Signs and symptoms associated with rectal infection can be mistaken for ulcerative colitis. Complications occur such as abscesses or fistulas occur when the infection becomes deep-seated.

Stage Features
  • Small painless papule appears.
  • Ulcerates, heals and disappears within a few days and may go unnoticed.
  • Most male patients present during this stage
  • About 2-6 weeks after the 1st stage painful and swollen lymph glands (buboes) develop on one (most common) or both sides of the groin.
  • Women may present with lower abdominal or back pain (deep pelvic node involvement).
  • Other symptoms include malaise, fever, chills, joint and muscular pain and vomiting.
  • Most female patients present during this stage with fever, pain, itch, pain on passing stools and urinating, and pus-filled or bloody diarrhoea.
  • Chronic inflammation may lead to abscesses, fistulaslymphatic obstruction, rectal strictures and proctocolitis.
  • Chronic infection may result in severe scarring causing major deformation of the genitals.

Laboratory tests for Lymphogranuloma venereum

LGV can be difficult to diagnose. Because of limitations of commercially available tests, diagnosis is primarily based on clinical findings.

Direct identification of the bacteria from a lesion or from the site of infection may be possible through testing for chlamydia but this would not indicate if the detected chlamydia strain is LGV. Also, currently available chlamydia tests have not been FDA approved for testing rectal specimens. ESR is working to validate diagnostic methods for LGV within New Zealand.

In a patient with rectal signs or symptoms suspicious for LGV, a health care provider should seek locally available expertise (eg microbiologist, sexual health physician, infectious disease specialist) about appropriate specimen collection and management.

Genital ulcer disease increases the risk of HIV infection so HIV testing should be undertaken as well.

What is the treatment for lymphogranuloma venereum?

LGV is treated with antibiotics to cure the infection and prevent ongoing tissue damage. Treatment with erythromycin or doxycycline for at least 3 weeks is required. Azithromycin has also been used. If necessary, large swollen lymph glands (buboes) may be drained. Surgery to repair fistulas and strictures may also be required.

All sexual activity should be refrained from until the condition has been treated successfully. Patients should be followed-up until all signs and symptoms of the infection have resolved.

Can lymphogranuloma venereum be prevented?

As with other STDs, if you think you are infected, stop all sexual contact and see your doctor or STD clinic immediately. Safe-sex practices will prevent the spread of LGV as well as other STDs.

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