- • In North America, lymphogranuloma venereum typically
presents as a proctitis syndrome; elsewhere, genital ulcer disease
followed by inguinal lymphadenopathy with or without bubo formation
- • Diagnostic tests include
culture and typing for Chlamydia trachomatis and
- • Patients should be asked about gender of sex partners
and travel to areas of endemic disease or outbreaks, and behavioral
risk assessment should be performed to elicit risks for transmission.
- • In patients with suspected infection, screening
for other STDs, including HIV, is warranted.
Lymphogranuloma venereum (LGV) is a systemic sexually transmitted
disease (STD) caused by L1, L2, and L3 serovars (subtypes) of Chlamydia trachomatis. LGV occurs worldwide
as several clinical syndromes, the most common of which are characterized
by papules or ulcers with inguinal lymphadenopathy, followed by
proctitis (see Table 17–1). Although LGV is classically
an invasive, inflammatory infection, patients may present without significant
lymphadenopathy or with mild symptoms. Asymptomatic infection also
has been observed.
Table 17–1. Characteristic Syndromes Associated with Lymphogranuloma Venereum. ||Download (.pdf)
Table 17–1. Characteristic Syndromes Associated with Lymphogranuloma Venereum.
|Primary stage||Incubation 3–30 d||• Typically small, painless genital papule with or without urethritis or cervicitis that may ulcerate|
|• Usually unrecognized by patient and resolves without treatment|
|Secondary stage||Occurs 2–6 wk after primary stage||• One or more regional lymph nodes that may ulcerate (ie, bubo); inguinal or femoral nodes may cause “groove” sign|
|• One third of buboes may rupture|
|• Genital ulcers may be manifest concurrently with lymphadenitis|
|Proctitis and proctocolitis||Risk factors include anal intercourse or other anal penetration||• Rectal discharge, bleeding, pain on defecation (tenesmus), and later, frank colitis; inguinal lymph node involvement is unusual|
|• Fever or other constitutional symptoms (ie, weight loss, fatigue) may be present|
LGV is endemic in some regions (Africa, Southeast Asia, Central
and South America, and Caribbean countries) while occurring sporadically
in others. It remains infrequent in the United States. However,
case clusters have been reported in the northern hemisphere since
2002. Notably, an outbreak of 92 cases of proctitis caused by LGV
was described among men who have sex with men (MSM) in the Netherlands
in 2003–2004. Since then, case clusters have been reported
in Belgium, France, Sweden, and Canada, with fewer than two dozen
confirmed cases reported throughout the United States by 2005.
Recent outbreaks and case clusters demonstrate the need for heightened
awareness of this STD in the United States. LGV should be considered
in those at risk for STDs, especially MSM and others reporting unprotected
receptive anal intercourse who present with rectal complaints or
lymphadenopathy. Such patients, along with any patient with a compatible
clinical presentation, should be asked about travel to areas of
endemic disease or outbreaks. Given the ulcerative nature of this
more invasive chlamydial infection, the risk of facilitating HIV
acquisition and transmission is ...