Lymphogranuloma venereum - A different type of chlamydia

Lymphogranuloma venereum (LGV) is a sexually transmitted disease that used to be primarily thought of as affecting individuals in the developing world, but it is now on the rise worldwide. After an initial outbreak in MSM in the Netherlands in 2003, LGV has been found in isolated groups of MSM across western Europe, North America, and Australia. LGV is closely associated with HIV infection and, as with many other STDs, can actually increase the risk of HIV transmission and acquisition.

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

What Are the Symptoms of LGV?

In some ways, infection with LGV is more similar to infection with syphilis than standard genital chlamydial infection. This is because infection has multiple stages, and symptoms can become systemic (spread throughout the body) instead of just local.

The first stage of LGV infection is a small bump, or papule, that may become ulcerated. This symptom usually appears approximately 1 to 2 weeks after exposure to the virus. The second stage, occurring approximately 2 to 6 weeks later, may include swollen lymph nodes, fever, and pain. Infected MSM who practice anal sex may also experience itching, discharge, and bleeding from their rectums. Swollen lymph nodes are less common in women with LGV.

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

How is LGV Diagnosed and Treated?

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, since bacteria may not always be visible depending on the stage of the illness.

Because Lymphogranuloma venereum is caused by a type of chlamydia, testing sores and inflamed lymph nodes for the presence of chlamydia can lead to a correct diagnosis. Most labs are incapable of distinguishing between a standard genital chlamydia infection and Lymphogranuloma venereum so the infection may end up being misdiagnosed. Still, the antibiotic treatment regimen is similar, and in the presence of a bubo containing chlamydia, it's a pretty safe bet that Lymphogranuloma venereum is the culprit rather than a standard genital strain.

Source:

McLean CA, Stoner BP, Workowski KA. "Treatment of lymphogranuloma venereum." Clin Infect Dis. 2007 Apr 1;44 Suppl 3:S147-52.