What is Lymphogranuloma Venereum?
Lymphogranuloma venereum (LGV) is a condition that causes open sores in the genital area. It’s caused by a kind of bacteria called Chlamydia trachomatis, particularly types L1, L2, and L3. It’s not very common and is transmitted through sexual activities, like vaginal, oral or anal sex. This infection has been increasingly reported in men who have sex with other men.
The infection has three stages:
- The first stage is marked by the appearance of a painless ulcer or small lumps in the genital area.
- In the second stage, one or both sides of the groin (the areas between your stomach and thigh) might swell and become tender. This swelling, also known as lymphadenopathy or “buboes”, can also affect the upper leg.
- The final stage can lead to tightening and scarring (fibrosis) in the genital area and possibly even fistula, a kind of abnormal connection between different body parts.
What Causes Lymphogranuloma Venereum?
The cause of this disease is a type of bacteria known as Chlamydia trachomatis, specifically the versions referred to as L1, L2, L3. Chlamydia is a common type of bacteria that is shaped like an oval. It needs to live inside cells to survive.
Risk Factors and Frequency for Lymphogranuloma Venereum
Lymphogranuloma venereum is a disease that’s common in tropical and subtropical regions worldwide, but it’s rare in the United States. It usually affects people between the ages of 15 to 40 who are sexually active. While it probably affects males and females equally, it’s often reported more in men because the early signs of the disease are more visible in them. It’s especially common in men who have sex with men and has a strong connection with HIV-infected patients. Typically, men show symptoms of the disease in its early stages, whereas women usually don’t show symptoms until the disease has reached later stages and complications have developed.
- Lymphogranuloma venereum is more common in tropical and subtropical regions around the world.
- It’s rare in the United States.
- The disease mostly affects sexually active individuals aged 15 to 40.
- Both men and women are likely to get it, but early signs are more noticeable in men.
- Men who have sex with men are particularly at risk.
- There’s a significant connection between HIV-infected patients and Lymphogranuloma venereum.
- Men typically experience early symptoms, while women often only develop symptoms in the late stages of the disease.
Signs and Symptoms of Lymphogranuloma Venereum
Evaluating lymphogranuloma venereum, a sexually transmitted disease, involves firstly taking a detailed patient history, including their sexual activity. This condition typically develops in three stages, each of which presents distinct symptoms:
- Primary Stage: This begins 3 to 12 days after exposure, though sometimes it can take up to 30 days. In this stage, patients typically develop painless genital ulcers or small skin bumps which are about 1 to 6 mm in size. Sores can also appear in the mouth or throat. These sores often go unnoticed because they are usually small and have no associated symptoms. Additionally, they can be located in areas that aren’t easily visible. The sores, however, tend to disappear on their own after some days.
- Secondary Stage: The secondary stage is marked by the appearance of painful swelling of the lymph nodes in the groin or thigh region. This can be either one-sided or on both sides and often occurs two to six weeks after the primary stage. An example of this stage is the “inguinal syndrome.” Other symptoms may include pain during urination, rectal bleeding, abdominal pain, and discomfort during bowel movements. You might also experience general body aches, fever, and headaches. For individuals who contracted the disease through oral sex, swollen neck lymph nodes could be noticed.
- Late Sequelae: This stage occurs when the disease hasn’t been treated. It can result in complications such as the rupture and death of lymph nodes, the development of abnormal passages called fistulae in the anal area, the formation of narrow bands of tissue called strictures in the genital area, and in some cases, a severe condition called elephantiasis of the genitals can occur.
There have also been reported cases of systemic complications like pneumonia and hepatitis, associated with the disease. Therefore, seeking medical treatment early is important to prevent these complications.
Testing for Lymphogranuloma Venereum
The diagnosis of LGV, a type of sexually transmitted infection, is often made based on the symptoms you’re experiencing and the doctor’s judgement. However, it’s important to rule out other causes of genital sores and swelling in the groin area.
For a more definitive diagnosis, doctors may use blood tests (known as serology tests), or they might look for the bacteria called Chlamydia trachomatis, which causes LGV. They do this by taking samples from your genitals, rectum, or from the swollen lymph nodes in your groin, and testing these samples in a lab. They can either try to grow the bacteria (culture), search for its DNA (nucleic acid amplification test), or use a special light microscope to see the bacteria (direct immunofluorescence).
Men who have sex with men, and are showing signs of infection in their rectum and colon, should be tested for LGV. For these patients, the preferred method of testing is the nucleic acid amplification test on a rectal sample.
Anybody getting tested for a sexually transmitted infection like LGV should also consider getting tested for HIV, as there is often overlap in the risk factors for these two types of infections.
Treatment Options for Lymphogranuloma Venereum
If a doctor suspects that you have LGV (a sexually transmitted infection that causes sores, bumps, or swelling in the genital area or rectum), they will likely start treating you for it even before the diagnosis is confirmed.
Typically, doxycycline is the first-choice medication to treat LGV. It’s taken by mouth, usually twice a day for about three weeks. However, if you’re pregnant or allergic to doxycycline, erythromycin is a safe alternative. In such cases, erythromycin would be taken four times a day for the same three weeks. Another alternative medication can be azithromycin, which only needs to be taken once a week for three weeks.
If you’re pregnant, you should avoid taking doxycycline and similar drugs since they can interfere with the normal growth and development of your baby’s bones and teeth.
If you have swollen lymph nodes that are filled with pus (also known as buboes) as a result of LGV, your doctor may recommend drawing out the fluid with a needle for relief. However, it’s usually not recommended to directly cut into and drain the nodes as it could slow down the healing process.
What else can Lymphogranuloma Venereum be?
Doctor often considers sexually transmitted diseases first when diagnosing LGV, a particular type of sexually transmitted infection. To pinpoint the correct condition, it’s important to rule out other diseases that show similar symptoms, such as:
- Herpes simplex
- Syphilis
- Chancroid
- Herpes
- Granuloma inguinale
HIV and lymphoma, two conditions that can also cause generalized enlargement of the lymph nodes, should be considered as well. Skin conditions and injuries that can cause genital ulcers should also be evaluated during the diagnosis process.
What to expect with Lymphogranuloma Venereum
If noticed and addressed quickly, the chances for a positive outcome are generally good.
Possible Complications When Diagnosed with Lymphogranuloma Venereum
When the condition isn’t treated, complications often arise. These can include the death and rupture of lymph nodes, the development of fibrous tissue in the anal and genital regions, and hardened, narrow areas of the body, such as anal fistulae. In some instances, there’s also a risk of enlarged genital organs, also known as elephantiasis. Furthermore, there’s a possibility of system-wide issues, like pneumonia and hepatitis.
Complications of Untreated Disease:
- Death and rupture of lymph nodes
- Fibrous tissue formation in anal and genital regions
- Hardened, narrow body areas (strictures)
- Anal fistulae
- Enlarged genital organs (elephantiasis)
- Pneumonia
- Hepatitis
Preventing Lymphogranuloma Venereum
Patients need to be aware of the early signs and symptoms of LGV (Lymphogranuloma venereum), a type of sexually transmitted infection. Having LGV can increase your risk of getting other sexual infections such as HIV, hepatitis, syphilis, chancroid, and gonorrhea. It’s important to understand the need for protection, like using condoms, during sexual activities.
If your sexual partner has tested positive or is likely positive for LGV, they should also get tested and treated if necessary. Men who engage in sex with other men should particularly be aware that LGV is common within these groups and should familiarize themselves with the signs and symptoms of LGV.
