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AT-A-GLANCE

AT-A-GLANCE

  • Lymphogranuloma venereum is a sexually transmitted infection caused by L serovars (serologic variants) of Chlamydia trachomatis.

  • Endemic in Africa, Southeast Asia, and South and Central America, and rare in developed countries.

  • Outbreaks have occurred among men who have sex with men in Europe, Australia, and North America.

  • Clinically manifests as inguinal and anorectal syndromes, in 3 stages.

  • Hematogenous spread with manifestations of systemic infection.

  • Diagnosis is by identification of organism and by serology or genotyping.

  • Doxycycline or azithromycin (second-line) treatment is curative if given early in the infection course.

EPIDEMIOLOGY

Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by specific Chlamydia variants that is rare in developed countries. It is endemic in East and West Africa, India, Southeast Asia, South and Central America, and some Caribbean Islands; LGV accounts for 7% to 19% of genital ulcer diseases in areas of Africa and India.1,2 The peak incidence occurs in sexually active persons 15 to 40 years of age, in urban areas, and in individuals of lower socioeconomic status. Men are 6 times more likely than women to manifest clinical infection.3 The incidence of LGV is low in the developed world where cases are usually limited to travelers or military personnel returning from endemic areas. Since 2003, however, outbreaks of LGV have appeared in Europe, Australia, and North America, particularly in the form of proctitis, among HIV-positive men who have sex with men (MSM).4-8 In 2013, more than 1000 cases were reported to the European Centre for Disease Prevention and Control, approximately 50% of them from the United Kingdom9; however, the real number is likely to be higher, as LGV is not routinely recorded in many European countries. In addition, a cluster of 38 LGV cases among MSM was reported in the United States in Michigan for the period August 2015 thru April 201610; the true incidence of LGV in the United States, however, is unknown because national reporting of LGV ended in 1995.

LGV is contracted by direct contact with infectious secretions, usually through any type of unprotected intercourse, whether oral, vaginal, or anal. Transmission efficiency is unknown.11 Asymptomatic rectal infection and/or penile and oral infection is the likely source of onward transmission.12 Sexual practices, such as fisting and sex-toy sharing, may be other routes of transmission. In a study that compared sexual behaviors in men with LGV and men with non-LGV chlamydial proctitis, fisting was a major predisposing factor.13 An epidemic of LGV has been reported among “crack” cocaine users in the Bahamas.14

As a consequence of underdiagnosis and underreporting, the epidemiology of LGV remains poorly understood. Common diagnostic laboratory methods are nonspecific and not readily available in endemic areas. Even in industrialized countries, only a few laboratories offer specific assays to LGV serovars (serologic variants).15 Without such assays, many LGV cases ...

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