Lymphogranuloma Venereum Symptoms and Treatment

Lymphogranuloma venereum (LGV) is a sexually transmitted disease that used to be thought of as affecting people in the developing world. Unfortunately, it is now on the rise worldwide.

There was an initial outbreak in men who have sex with men (MSM) in the Netherlands in 2003. After that, LGV started to be found in isolated groups of MSM across western Europe, North America, and Australia.

LGV is closely associated with HIV infection. Also, as with many other STDs, lymphogranuloma venereum can actually increase the risk of getting HIV.

LGV is caused by a type of chlamydia. Numerous types of chlamydia infect humans. Serovars D-K cause standard genital infections. Serovars A-C cause trachoma (blindness). Serovars L1, L2, and L3 cause LGV.

This article discusses the risk factors and symptoms of LGV and how it's diagnosed and treated.

Risk Factors

One of the main risk factors for LGV is being HIV positive. A study found that MSM with LGV are eight times more likely to have HIV than those with non-LGV chlamydia.

Unprotected sex is another key risk factor for LGV. The infection can be transmitted during unprotected vaginal and anal sex.

LGV is diagnosed more in men than in women. In 2019, more than 3,000 cases of LGV were reported in 23 countries in Europe. Almost all cases reported were men who have sex with men. Only 10 cases were reported among women.

However, the exact number of LGV cases in the United States is unknown. That's because the diagnostic tests to differentiate LGV from non-LGV chlamydia aren't widely used.

Symptoms

In some ways, infection with LGV is more similar to infection with syphilis than standard genital chlamydial infection. Like syphilis, symptoms can become systemic (spread throughout the body) rather than staying in a limited area.

LGV is also similar to syphilis in that the infection has multiple stages. The first stage usually happens within one to two weeks. The second stage is usually between two and six weeks after infection.

First stage:

• A small bump, or papule
• Ulcerations of the skin are possible

Second stage:

• Enlarged lymph nodes around the groin (less common in women)
• Fever
• Malaise
• Back or pelvic pain
• Itching, discharge, and bleeding from the rectum
  

Complications

The third stage, or late stage, of LGV can lead to significant complications. These include:

• Abscesses (collections of pus)
• Fistula (abnormal, oozing tunnel around the rectum)
• Rectal strictures (narrowing)
• Severe genital swelling
• Genital deformation
• Pelvic organ dysfunction
• Infertility

If LGV remains untreated, it can become chronic and cause long-term damage to the lymphatic system. This is similar to how untreated chlamydia may lead to pelvic inflammatory disease. Problems usually appear approximately five to ten years after the initial infection.

Diagnosis

Your healthcare provider will give you a physical exam and ask about your medical and sexual history. If LGV is suspected based on symptoms, tests may include:

• Biopsy of swollen lymph node
• Blood test for LGV
• Laboratory test for chlamydia
  

Misdiagnosis

Lymphogranuloma venereum can be extremely difficult to test for. In order to get a correct diagnosis, doctors have to be both familiar with the illness and take a very careful medical history. Simply examining material from the sores may not give a clear result. Bacteria may not always be visible, depending on the stage of the illness.

Your doctor may test your sores and inflamed lymph nodes for the presence of chlamydia. Most labs can't tell the difference between a standard chlamydia infection and Lymphogranuloma venereum. That means it may end up being misdiagnosed as chlamydia, rather than LGV.

To help your doctor get the right diagnosis, make sure you give them complete information about your medical and sexual history. If you have rectal signs or symptoms that are suspicious for LGV, your doctor may collect samples to send for further testing.

Samples may be sent to a state health department to refer to the Centers for Disease Control and Prevention (CDC). The CDC works with state health departments to test the samples and verify diagnosis for LGV.

Treatment

LGV is usually treated with the antibiotic doxycycline (100 mg) twice daily for 21 days. According to the CDC, this treatment cures more than 98.5% of cases. Treatment may be longer for severe cases.

Other options for antibiotics include azithromycin or erythromycin.

Let your sexual partners know of your diagnosis. This should be anyone you've had sex with during the 60 days since your symptoms started. That way, they can get treatment before symptoms or complications start.

Avoid any sexual activity until after treatment is completed.

Summary

Risk factors for LGV include having unprotected sex and being HIV-positive. While tests for LGV aren't always widely available, your doctor may suspect LGV based on symptoms and your sexual history. With antibiotic treatment, LGV is almost always curable.

A Word From Verywell

It can be uncomfortable to talk with your doctor about your sexual history. However, it's important to let them know if you think you've been exposed to LGV.

Your doctor can help you spot any signs or symptoms that look like LGV. If you are diagnosed, you can get treatment to avoid complications and help protect others from getting it as well.