Lymphogranuloma Venereum (LGV)
By: Trever Jones 2006.03.05
What is LGV?
LGV is also known as lymphogranuloma inguinale and tropical bubo. It is an infection caused by a variant of the bacterium Chlamydia trachomatis, which causes chalymdia. Unlike an ordinary chlamydia infection, LGV is a systemic disease that may cause painful swelling of the lymph nodes (glands) in the groin area. Until very recently, it was considered a disease of Africa, Asia, Central and South America, and the Caribbean countries. However, in November 2004, the Netherlands said 92 cases of LGV had been reported over the preceding year, compared to the usual 2 or 3 cases. Other cases have been reported in the United Kingdom, Belgium, France, and Sweden. Cases have now been reported in New York, Atlanta, and San Francisco, where it is being treated as an outbreak, in an aggressive effort to prevent the spread of this disease.
Transmission
- Spread by direct sexual contact with the genitals, rectum, or mouth of an infected partner.
- Most closely associated with unprotected anal sex and men who have sex with men.
- May be associated with a new sexual partner or having multiple sexual partners.
- Higher prevalence in those who are HIV positive.
- Higher prevalence in those with other STDs.
Signs & Symptoms
General - Occurs in Three Stages.
- First Stage—occurs from 3 days to 6 weeks (10-14 days average) after exposure. Signs and symptoms are a painless papule (blister-like or ulcer like) on the genital area. This sore does not appear in everyone, or may go unnoticed in the urethra (urine tube), vagina, or rectum. It heals in a few days. Typically, when the lesions are seen, they are on the head of the penis in men, and on the vaginal wall in women. A thick, foul smelling discharge may occur in men or women.
- Second Stage—occurs 2-6 weeks after the first stage. Males may show painful, swollen inguinal glands (on the front of the body in the crease where the leg joins the body), usually just on one side. These may burst, leading to open draining wounds that take months to heal. Women may complain of lower abdominal or back pain because they often have inflammation of the glands deeper in the body due to involvement of the rectum or vaginal area. Men or women with systemic spread of the bacteria may show arthritis, penumonitis, and hepatitis. Vaginal itching and irritation
- Third Stage—May occur years after infection. Women are most likely to seek treatment at this stage. Fever, pain, itching, and bloody or pus filled diarrhea are likely to be present, due to internal abscesses and complications.
Complications
Pregnancy:
- Newborns can contract the disease from infected mothers during birth.
General: Usually arise from progression to third stage.
- Genital deformation
- Rectal swelling, fissures, abscesses
- Bowel blockages
- Rupture of the colon—can be fatal.
Diagnosis
A health care provider must diagnose LGV.
- Visual inspection.
- Microscopic examination of discharge.
- Rule out other disorders.
Treatment
- Recommended treatment is with doxycycline (antibiotic), combined with draining fluid from the lymph nodes, if indicated.
- Application of heat, and taking non-steroidal anti-inflammatories for pain relief.
- Surgery may be needed for repair of late complications, such as abscesses, fistulas, ruptured bowel.
Prevention
- Use of latex or polyurethane condoms correctly every time you have sex may help reduce the possibility of LGV
- Limit the number of sex partners.
- Practice sexual abstinence, or limit sexual contact to one partner.