Lymphogranuloma venereum

Answer 1

Definition

Lymphogranuloma venereum (LGV) is a sexually transmitted bacterial infection.

Alternative Names

LGV; Lymphogranuloma inguinale; Lymphopathia venereum

Causes, incidence, and risk factors

Lymphogranuloma venereum (LGV) is a chronic (long-term) infection of the lymphatic system caused by three different types of the bacteria Chlamydia trachomatis. The bacteria spread through sexual contact. The infection is caused by a different bacteria than that which causes genital chlamydia.

LGV is more common in Central and South America than in North America. Every year, a few hundred cases of LGV are diagnosed in the United States. However, the actual number of infections is unknown.

LGV is more common in men than women. The main risk factor is having multiple sexual partners.

Symptoms

Symptoms of LGV can begin a few days to a month after coming in contact with the bacteria. Symptoms include:

• Small painless ulcer on the male genitalia or in the female genital tract
• Swelling and redness of the skin in the groin area
• Swollen groin lymph nodes on one or both sides; it may also affect lymph nodes around the rectum in those who have anal intercourse
• Drainage through the skin from lymph nodes in groin
• Blood or pus from the rectum (blood in the stools)
• Painful bowel movements (tenesmus)
• Swelling of the labia

The infection can cause diarrhea and lower abdominal pain. Women may develop abnormal connections called fistulas between the vagina and rectum.

Signs and tests

The health care provider will perform a physical examination and ask questions about your medical history. It is important to tell your doctor if you had sexual contact with someone who has had lymphogranuloma venereum.

A physical exam may show:

• An ulcer on the genitals
• An oozing, abnormal connection (fisula) in the rectal area
• Swollen lymph nodes in the groin (inguinal lymphadenopathy)
• Drainage through the skin from lymph nodes in the groin
• Swelling of the vulva or labia in women

Tests may include:

• Biopsy of the lymph node
• Blood test for the bacteria that causes LGV
• Laboratory test to detect chlamydia

Treatment

This condition can be cured with the proper antibiotics. Those commonly prescribed to treat LGV include tetracycline, doxycycline, and erythromycin.

Expectations (prognosis)

With treatment, the outlook is good.

Complications

• Abnormal connections between the rectum and vagina
• Brain inflammation (very rare)
• Infections in the joints, eyes, heart, or liver
• Long-term inflammation and swelling of the genitalia
• Scarring and narrowing of the rectum

Complications can occur many years after the initial infection.

Calling your health care provider

Call your health care provider if you have been in contact with someone who may a sexually transmitted disease, including LVG. Also call if symptoms of LVG develop.

Prevention

Abstaining from sexual activity is the only absolute way to prevent a sexually transmitted disease. Safer sex behaviors may reduce the risk.

The proper use of condoms, either the male or female type, greatly decreases the risk of catching a sexually transmitted disease. You need to wear the condom from the beginning to the end of each sexual activity.

References

Stamm WE, Jones RB, Batteiger BE. Chlamydia trachomatis (trachoma, perinatal infections, lymphogranuloma venereum, and other genital infections). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2005:chap 177.

Eckert LO, Lentz GM. Infections of the lower genital tract: vulva, vagina, cervix, Toxic shock syndrome, HIV infections. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 22.

Centers for Disease Control and Prevention, Workowski KA, Berman SM. Diseases characterized by genital ulcers. Sexually transmitted diseases treatment guidelines 2006. MMWR Morb Mortal Wkly Rep. 2006 Aug 4;55(RR-11):14-30.

Answer 2

Definition

Lymphogranuloma venereum (LGV) is a sexually transmitted bacterial infection.

Alternative Names

LGV; Lymphogranuloma inguinale; Lymphopathia venereum

Causes, incidence, and risk factors

Lymphogranuloma venereum (LGV) is a chronic (long-term) infection of the lymphatic system caused by three different types of the bacterium Chlamydia trachomatis. The bacteria spread through sexual contact. The infection is not caused by the same bacteria that cause genital chlamydia.

LGV is more common in Central and South America than in North America. Every year, a few hundred cases of LGV are diagnosed in the United States. However, the actual number of infections is unknown.

LGV is more common in men than women. The main risk factor is being HIV-positive.

Symptoms

Symptoms of LGV can begin a few days to a month after coming in contact with the bacteria. Symptoms include:

• Blood or pus from the rectum (blood in the stools)
• Drainage through the skin from lymph nodes in the groin
• Painful bowel movements (tenesmus)
• Small painless sore on the male genitals or in the female genital tract
• Swelling and redness of the skin in the groin area
• Swelling of the labia
• Swollen groin lymph nodes on one or both sides; it may also affect lymph nodes around the rectum in people who have anal intercourse

The infection can cause diarrhea and lower abdominal pain.

Signs and tests

The health care provider will perform a physical examination and ask questions about your medical history. It is important to tell your doctor if you had sexual contact with someone who has had lymphogranuloma venereum.

A physical exam may show:

• An oozing, abnormal connection (fisula) in the rectal area
• A sore on the genitals
• Drainage through the skin from lymph nodes in the groin
• Swelling of the vulva or labia in women
• Swollen lymph nodes in the groin (inguinal lymphadenopathy)

Tests may include:

• Biopsy of the lymph node
• Blood test for the bacteria that causes LGV
• Laboratory test to detect chlamydia

Treatment

This condition can be cured with the right antibiotics. Antibiotics that are commonly prescribed to treat LGV include tetracycline, doxycycline, erythromycin, and azithromycin.

Expectations (prognosis)

With treatment, the outlook is good.

Complications

• Abnormal connections between the rectum and vagina
• Brain inflammation (very rare)
• Infections in the joints, eyes, heart, or liver
• Long-term inflammation and swelling of the genitals
• Scarring and narrowing of the rectum

Complications can occur many years after you are first infected.

Calling your health care provider

Call your health care provider if:

• You have been in contact with someone who may a sexually transmitted disease, including LGV
• You develop symptoms of LGV

Prevention

Abstaining from sexual activity is the only absolute way to prevent a sexually transmitted disease. Safer sex behaviors may reduce the risk.

The proper use of condoms, either the male or female type, greatly decreases the risk of catching a sexually transmitted disease. You need to wear the condom from the beginning to the end of each sexual activity.

References

Stamm WE, Batteiger BE. Chlamydia trachomatis(trachoma, perinatal infections, lymphogranuloma venereum, and other genital infections). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 180.

Eckert LO, Lentz GM. Infections of the lower genital tract: vulva, vagina, cervix, toxic shock syndrome, HIV infections. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 22.

Workowski KA, Berman S. Centers for Disease Control and Prevention, Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines 2010. MMWR Morb Mortal Wkly Rep. 2010 Dec 17;59:1-110.

Reviewed By

Review Date: 08/24/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.