What is Lymphogranuloma venereum (LGV)?
Lymphogranuloma venereum (LGV) is an uncommon sexually transmitted disease (STD) caused by Chlamydia trachomatis. It is rare in industrialized countries. LGV is more commonly seen in third-world countries, including certain areas of Africa, Southeast Asia, India, the Caribbean, and South America.
However, in recent times, more cases of LGV have been noted in first-world countries.
What is Chlamydia VS Lymphogranuloma venereum (LGV)?
Chlamydia trachomatis is the name of the bacteria that causes Lymphogranuloma venereum (LGV). LGV refers to clinical disease.
Not all subtypes of Chlamydia cause LGV. Of the 15 known clinical serotypes, only the L1, L2, and L3 serotypes cause LGV.
These serotypes are more virulent and invasive compared to other chlamydial serotypes.
What are the signs and symptoms of LGV?
Lymphogranuloma venereum (LGV) occurs in 3 stages:
First Stage of LGV
In the first stage, LGV presents with self-limited genital ulcers which may appear anywhere from 3 days to 1 month after exposure. This may be small and/or painless and may be missed by the patient. It may even look like a herpes infection.
The Second stage of LGV
In the second stage, the patient usually presents with painful lymph node swelling in the inguinal and/or femoral groups of lymph nodes, usually appearing 2-6 weeks after exposure.
Other groups of lymph nodes may be involved as well, such as the armpit or neck lymph nodes. Painful, swollen lymph nodes may coalesce (join together) to form buboes, which may rupture in as many as one-third of patients.
Those that do not rupture harden, then slowly resolve. The second stage may be associated with back pain, joint pain, inflamed eyes, cardiac inflammation, lung inflammation or liver inflammation if the bacteria disseminate from the local area of infection.
Last Stage of LGV
In the last stage, patients with LGV may present with rectal ulcerations and symptoms of inflammation of the rectum which include bloody purulent anal discharge, rectal pain and the feeling of incomplete evacuation after passing stools.
This is more common in patients participating in receptive anal intercourse.
This may occur many months or even years after the initial infection. This can cause lasting damage to infected tissue and general health.
Scarring, swelling and deformity in infected areas have also been reported. It may affect your gut as well, resulting in significant morbidity.
What are the other common STD Symptoms:
These are signs and symptoms caused by the Herpes Simplex Virus and Human papillomavirus (HPV).
Not all STDs will display signs and symptoms. Other typical signs & STD symptoms of Sexually Transmitted Infections (STIs) are as followed.
Is LGV Associated with Other Subtypes of Genital Ulcer Diseases such as Herpes Simplex Virus 2 (HSV-2), Syphilis, and Chancroid?
Lymphogranuloma venereum (LGV) is one of the causes of genital ulcer diseases that includes other STDs, such as Herpes Simplex Virus 2, Syphilis, and Chancroid. Any other form of STDs increases your risk of contracting another STD, including LGV.
How is Lymphogranuloma venereum (LGV) Transmitted?
LGV is almost exclusively transmitted through sexual contact.
Infection occurs after direct contact with the skin or mucous membranes of an infected partner. The organism does not penetrate intact skin.
The organism then travels by lymphatics to nearby lymph nodes, where it replicates within a type of white blood cell known as macrophages and causes systemic disease.
Can Sharing of Sex Toys Transmit Lymphogranuloma venereum (LGV)?
As long as the Chlamydia bacteria is present on the surface of the sex toy, and was introduced to the anogenital mucous membranes on the anus, vagina or penis, the infection can be spread.
It is thus important to make sure that sex toys are clean. It is also important to keep your sex toys clean.
How about Rectal Douching or Vaginal Douching?
Rectal and vaginal douching does not cause LGV, as if the surfaces of the douching tool is clean, there will not be the Chlamydia bacteria.
Having said that, most doctors do not recommend vaginal douching for ladies, as it may affect the normal flora of the vaginal cavity.
How Do I Test for Lymphogranuloma venereum (LGV)?
Laboratory diagnosis ultimately depends on detecting Chlamydia in the lesions/ulcers.
We can do a swab test of any lesions and do a urine test to see if Chlamydia is present or not.
What are the treatments for Lymphogranuloma venereum (LGV)?
LGV can be treated with antibiotics. However, a longer course has to be given (3 weeks). Your doctor will choose the appropriate antibiotic for you.
Sex partners who have had contact with the patient within the past 60 days should be evaluated and treated if symptomatic. If no symptoms are present, they should be treated for exposure, usually with shorter courses of antibiotics.
It is possible to be re-infected with LGV again after being successfully treated. Make sure all of your sexual partners have also been treated.
Is LGV more prevalent in MSM? How about other groups (Heterosexual & WSW)?
LGV has been postulated to probably affect both sexes equally, although it is more commonly reported in men. This could be because early signs and symptoms of LGV are more apparent in men and are therefore might be diagnosed more readily. Men typically present with the acute form of the disease, whereas women often present later.
Most cases in Europe and North America have been identified among white, frequently HIV-positive Men-Who-Have-Sex-with-Men (MSM) patients presenting with proctitis.
What are other STDs prevalent in Men Who Have Sex with Men?
Receptive anal sex carries the highest risk of contraction of all forms of STDs. STDs, in general, can affect everyone regardless of gender, age or sexual preference. If you are involved in sexual activity and have been exposed to an STD, you can contract it.
It is therefore important for you to get regularly tested for all STDs as long as there has been a new sexual encounter.
The best way to reduce the contraction of an STD from a sexual exposure is to use a condom. The proper usage of a condom (right size and fit) is equally important.