Lymphogranuloma venereum starts as a small, often unnoticed blister that quickly heals, then causes the lymph nodes to swell and become tender.
Doctors suspect the infection based on symptoms and confirm the diagnosis with blood tests.
Antibiotics can cure the infection, but lymph nodes that remain swollen may need to be drained.
Using condoms during sex can help prevent passing lymphogranuloma venereum and other sexually transmitted infections (STIs) from one person to another.
(See also Overview of Sexually Transmitted Infections.)
Lymphogranuloma venereum is caused by types of Chlamydia trachomatis that are different from those that usually cause infection of the urethra (urethritis), cervix (cervicitis), and eyes (trachoma).
Lymphogranuloma venereum is common in parts of Africa, Southeast Asia, and other areas of the world. However, rates of this infection are increasing in Europe, North America, and Australia among men who have sex with men. It is diagnosed much more often in men than women.
Rectal infections caused by these bacteria are seen in people who engage in anal sex.
Symptoms of LGV
Symptoms of lymphogranuloma venereum occur in 3 stages.
In stage 1, a small, painless, fluid-filled blister develops about 3 days after infection, usually on the penis or in the vagina. Typically, the blister becomes a sore that quickly heals and is often unnoticed.
Stage 2 usually begins after about 2 to 4 weeks.
In men, the lymph nodes in the groin on one or both sides may swell and become tender and form a bubo. A bubo is an enlarged and tender group of lymph nodes in the same area. Buboes sometimes become stuck together, in some cases forming a collection of pus (abscess). Buboes stick to deeper tissues and cause the overlying skin to become inflamed.
Women often have a backache or pain in the pelvis, and lymph nodes near the rectum and in the pelvis become swollen and painful.
In both men and women, the skin over the affected lymph nodes may break down, forming a passageway (called a sinus tract) that allows pus or blood to drain out and onto the skin. People may have a fever and feel generally unwell.
In stage 3, sores heal with scarring, but sinus tracts may not go away or may return. If infection lasts a long time or returns, lymphatic vessels (which drain fluids from tissues) may be blocked, causing genital tissues to swell and sores to form on the skin.
Rectal infection may occur at any stage. It may initially cause rectal discomfort or a bloody, pus-filled discharge from the anus. The infection may cause inflammation and then scarring, which can narrow the rectum. Lymph glands in the pelvis may swell, causing pain.
Diagnosis of LGV
Nucleic acid amplification testing (NAAT) of a sample of discharge from the vagina or rectum or of a sample of urine
Tests on a sample of blood
Lymphogranuloma venereum is suspected in people who have characteristic symptoms and who live in or have visited areas where the disease is common or who have had sexual contact with people from those areas.
In most cases, doctors diagnose lymphogranuloma venereum by doing NAAT to detect the bacteria’s unique genetic material, its DNA or RNA (which are nucleic acids). NAAT uses a process that increases the amount of the bacteria's DNA or RNA so that it can be more easily identified. Samples may be taken from the rectum, ulcers on the genitals or in the mouth, or from lymph nodes.
If NAAT is not available, doctors do a blood test that identifies antibodies against Chlamydia trachomatis.
Treatment of LGV
An antibiotic
Doxycycline taken by mouth for 21 days is the preferred antibiotic for treatment of lymphogranuloma venereum. Alternatively, erythromycin or azithromycin can be used. After treatment, people should be retested in 3 months. Doxycycline taken by mouth for 21 days is the preferred antibiotic for treatment of lymphogranuloma venereum. Alternatively, erythromycin or azithromycin can be used. After treatment, people should be retested in 3 months.
Doctors may also use a needle or make an incision to drain buboes (swollen lymph nodes) if they are causing discomfort.
If people have had sexual contact with an infected person during the 60 days before the person's symptoms began, they should be examined and treated with doxycycline taken by mouth for 7 days regardless of whether evidence suggests that they have lymphogranuloma venereum. Alternative antibiotics are azithromycin and levofloxacin.If people have had sexual contact with an infected person during the 60 days before the person's symptoms began, they should be examined and treated with doxycycline taken by mouth for 7 days regardless of whether evidence suggests that they have lymphogranuloma venereum. Alternative antibiotics are azithromycin and levofloxacin.
Prevention of LGV
People can do the following to help reduce their risk of lymphogranuloma venereum and other STIs:
Practice safer sex, including using a condom every time for oral, anal, or genital sex.
Reduce the number of sex partners and not have high-risk sex partners (people with many sex partners or who do not practice safer sex).
Practice mutual monogamy or abstinence.
Vaccinate (available for some STIs).
Seek prompt diagnosis and treatment to prevent spread to other people.
Identify sexual contacts if infected with an STI for the purposes of counseling and treatment.
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