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Lymphogranuloma venereum

LGV; Lymphogranuloma inguinale; Lymphopathia venereum

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

Causes

LGV is a long-term (chronic) infection of the lymphatic system. It is caused by certain strains of the bacteria Chlamydia trachomatis. The bacteria are spread by 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.

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:

  • Drainage through the skin from lymph nodes in the groin
  • Painful bowel movements
  • 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 (in women)
  • Swollen groin lymph nodes on one or both sides; it may also affect lymph nodes around the rectum in people who have anal intercourse
  • Blood or pus from the rectum (blood in the stools)

Exams and Tests

The health care provider will examine you. You will be asked about your medical and sexual history. Tell your provider if you had sexual contact with someone you think has had symptoms of LGV.

A physical exam may show:

  • An oozing, abnormal connection (fistula) 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

Tests may include:

  • Biopsy of the lymph node
  • Blood test for the bacteria that causes LGV
  • Laboratory test to detect chlamydia from genital lesions, pharyngeal, rectal and lymph node specimens

Treatment

LGV is treated with antibiotics, including doxycycline and erythromycin.

Outlook (Prognosis)

With treatment, the outlook is good and complete recovery can be expected.

Possible Complications

Health problems that may result from LGV infection include:

  • Abnormal connections between the rectum and vagina (fistula)
  • Brain inflammation (encephalitis - 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.

When to Contact a Medical Professional

Contact your provider if:

  • You have been in contact with someone who may have an STI, including LGV
  • You develop symptoms of LGV

Prevention

Not having any sexual activity is the only way to prevent an STI. Safer sex behaviors may reduce the risk.

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

References

Batteiger BE, Tan M. Chlamydia trachomatis (trachoma, urogenital infections). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 180.

Eckert LO, Lentz GM. Genital tract infections: vulva, vagina, cervix, toxic shock syndrome, endometritis, and salpingitis. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 23.

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      Review Date: 9/1/2021

      Reviewed By: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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