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Lymphogranuloma venereum

Definition

LGV is a sexually-transmitted disease (STD) caused by the bacteria Chlamydia trachomatis that causes inflammation and drainage of certain lymph nodes, and destruction and scarring of surrounding tissue.

Causes, incidence, and risk factors

Lymphogranuloma venereum (LGV) is caused by 3 subtypes of C. trachomatis. They are different organisms from the subtypes that cause eye disease, blindness, and the more common genital chlamydia.

LGV is more common in Central and South America than in North America. People with LGV can begin to have symptoms a few days to a month after becoming infected.

The disease starts as a painless ulcer on the male genitalia or in the female genital tract. As the organism spreads, the inguinal (groin) lymph nodes swell, become tender, and may rupture and drain through the skin. These enlarged nodes are called buboes.

The skin above the lymph node is often swollen (edematous) and red. These areas may appear to heal, but the patient will have repeated episodes of lymph node swelling and drainage. The patient may also have systemic signs including fever, decreased appetite, and malaise.

In people who practice anal intercourse, the disease can also affect the lymph nodes around the rectum (perirectal). This is often accompanied by bloody rectal discharge, painful defecation (tenesmus), diarrhea, and lower abdominal pain. Women may develop fistulas (connections) between the vagina and rectum.

There are a few thousand cases of LGV each year in the US. The main risk factor is having multiple sexual partners.

Symptoms

  • Small painless ulcer on genitalia
  • Swelling and redness of the skin over the inguinal lymph nodes
  • Swollen groin (inguinal) lymph nodes on one or both sides
  • Drainage from inguinal lymph nodes
  • Drainage of blood or pus from the rectum (blood in the stools)
  • Pain while having a bowel movement (tenesmus)

Signs and tests

The medical history and physical examination may show:

  • A history of sexual contact with a person having lymphogranuloma venereum
  • An ulcer on an affected person's genitals
  • A perianal fistula with drainage
  • Inguinal lymph node enlargement (inguinal lymphadenopathy)
  • Drainage from inguinal lymph nodes
Tests:
  • Biopsy of the node (chlamydia seen after staining)
  • Culture of a node aspirate for chlamydia (a needle is inserted into the lymph node and fluid is pulled out of the node)
  • Indirect immunofluorescence for chlamydia
  • Serology test for LGV is the most useful

Treatment

Lymphogranuloma venereum can be cured by proper antibiotic therapy. Commonly prescribed medications include:

  • Tetracycline, 500 mg by mouth, four times per day for 3 weeks
  • Doxycycline, 100 mg by mouth, twice a day for 3 weeks
  • Erythromycin, 500 mg by mouth, four times per day for 3 weeks
Note: Oral tetracycline is usually not prescribed for children until after all the permanent teeth have erupted. It can permanently discolor teeth that are still forming.

Expectations (prognosis)

Recovery and a shorter course of illness is expected with treatment.

Complications

  • Rectal stricture (scarring and narrowing of the rectum)
  • Elephantiasis of the genitalia (enlargement and chronic inflammation)
  • Rectovaginal fistula (an opening between the rectum and vagina)
  • Meningoencephalitis (brain inflammation), very rare

Calling your health care provider

Call your health care provider if you suspect you have been exposed to lymphogranuloma venereum or you have symptoms suggestive of LVG.

Prevention

Abstinence is the only absolute way to prevent sexually transmitted disease. Safer sex behaviors may reduce the risk. A monogamous sexual relationship with a person known to be free of any STD is advisable.

The use of condoms, either the male or female type, markedly decreases the likelihood of contracting a sexually-transmitted disease but they must be used properly. The condom should be in place from the beginning to end of sexual activity and should be used EVERY time the person engages in sexual activity with a non-monogamous or other suspect partner.

Condoms are effective and inexpensive considering the consequences of contracting a sexually transmitted disease.

Illustrations

Lymphatic system
Lymphatic system

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