Lymphogranuloma venereum

Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by an aggressive form of Chlamydia trachomatis. LGV is caused by one of three (L1, L2 or L3) serovars (group antigenic variants) of C. trachomatis. The organism targets the lymphatic system and lymph nodes. In the developed world, LGV is regarded as a rare disease.

LGV is a chronic disease that has a variety of acute and late manifestations. The primary lesion of LGV presents as a small, non-painful genital papule that may ulcerate. The secondary stage is characterized by acute lymphadenopathy (i.e. swelling of one or more lymph nodes) and/or acute haemorrhagic proctitis (i.e. inflammation of the rectum) following rectal intercourse associated with fever and other symptoms caused by the spread of infection.

The vast majority of patients recover from LGV after the secondary stage without lasting effects, but in a few patients the persistence of Chlamydia in anogenital tissue incites a chronic inflammatory response and the development of genital ulcers, fistulas (abnormal connections between blood vessels and tissues), rectal strictures, and genital elephantiasis. Antibiotic treatment during the secondary stage prevents late complications. On rare occasions where infection remains untreated meningoencephalitis (i.e. a form of brain inflammation), hepatitis and death have been reported.

LGV is most common in tropical and subtropical areas of the world and is generally rare in Europe. However since 2003, outbreaks of LGV among men who have sex with men (MSM) have been reported in European countries (Netherlands, Belgium, France, Germany, Sweden and the UK) as well as the US and Canada. The first outbreak in Ireland has been recently notified and cases are among MSM in the greater Dublin area. The majority of LGV patients were found to be HIV positive. All reported a variety of sexual risk behaviours, including unprotected anal sex, with numerous anonymous partners. All current European cases have been of the L2 genotype. A summary of LGV outbreaks among MSM in Europe is provided in Table 1.4 of the report STI and HIV prevention in MSM published by ECDC (available at http://ecdc.europa.eu/en/publications/Publications/STI-HIV-prevention-MSM-in-Europe-21-Feb-2013.pdf).

 

Last updated: 17 October 2014