Lymphogranuloma venereum

Definition

Lymphogranuloma venereum (LGV) is a sexually transmitted bacterial infection caused by Chlamydia trachomatis serovars L1, L2, and L3. It features acute lymphadenopathy with bubo formation and can progress to chronic inflammatory sequelae including lymphatic obstruction and tissue scarring.

Symptoms of Lymphogranuloma Venereum

LGV progresses through three clinical stages. The primary stage involves a transient, painless papule, pustule, or ulcer at the inoculation site that often goes unnoticed. The secondary stage (1-6 weeks later) is characterized by painful inguinal lymphadenopathy, typically unilateral, with bubo formation. The 'groove sign' is pathognomonic when lymph nodes above and below the inguinal ligament are enlarged. Systemic symptoms include fever, headache, myalgia, and arthralgia. In MSM, acute proctocolitis with rectal discharge and bleeding is common. The tertiary stage involves chronic inflammatory sequelae with lymphatic obstruction, elephantiasis, and anogenital scarring.

Clinical Images

Transmission of Lymphogranuloma Venereum

LGV is transmitted through direct contact with infected genital lesions, ulcer exudate, or infected lymphatic material during sexual activity. The bacterium enters through micro-abrasions in mucous membranes or skin. LGV has re-emerged as a significant pathogen in men who have sex with men, particularly in HIV-positive individuals, where it commonly presents as proctocolitis. Asymptomatic rectal carriage contributes to ongoing transmission in high-risk networks.

Incubation Period

Typical period: 3-30 days

The incubation period for the primary lesion of LGV is 3-30 days. The secondary stage with lymphadenopathy typically develops 1-6 weeks after exposure, though the primary lesion may have healed by this time. The variable and often prolonged incubation period between stages can make clinical diagnosis challenging.

Complications of Lymphogranuloma Venereum

Untreated LGV can lead to severe and permanent complications. Chronic lymphatic obstruction causes progressive genital elephantiasis and lymphangitis. Anogenital fistulas and strictures develop from chronic inflammation and fibrosis. Esthiomene is a chronic destructive ulcerative condition of the external genitalia. Rectal strictures can cause obstruction requiring surgical intervention. Systemic complications include reactive arthritis, hepatitis, and rarely, pericarditis. Early diagnosis and treatment are essential to prevent irreversible sequelae.

Treatment Options for Lymphogranuloma Venereum

LGV requires extended antibiotic therapy (21 days) due to the intracellular nature of Chlamydia trachomatis serovars L1-L3. Clinical response should be monitored, and treatment continued until all symptoms have resolved. Buboes may require aspiration through healthy adjacent skin to prevent rupture and fistula formation. All sexual partners within the preceding 60 days should be examined and treated. Patients should be tested for HIV, syphilis, and other STIs. Follow-up is recommended until all symptoms have resolved.

Prevention of Lymphogranuloma Venereum

Prevention of LGV follows standard STI prevention strategies. Condoms effectively reduce transmission risk. Regular STI screening in high-risk populations, particularly MSM and HIV-positive individuals, enables early detection and treatment. Partner notification and treatment are essential to prevent reinfection and further spread. Health education should focus on recognition of symptoms (particularly lymphadenopathy and proctocolitis) and the importance of seeking prompt medical care.