Lymphogranuloma Venereum

What is Lymphogranuloma Venereum (LGV)?

Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by certain strains of Chlamydia trachomatis bacteria. It is primarily spread through sexual contact, but can also be contracted through skin-to-skin contact or by using contaminated objects. It is rare in women, but common in men, especially those who have sex with men.

The early symptoms of LGV are often mild and may include itching or pain in the genital area, followed by the appearance of small, painless sores. These sores may then progress to swelling of the lymph nodes and eventually cause inflammation of the lymphatic vessels and surrounding tissues, leading to genital ulceration, abscess formation, and scarring.

If left untreated, LGV can cause serious health problems, including infertility, rectal strictures, and fistulas. However, with prompt diagnosis and treatment, most people can fully recover from the infection.

Treatment for LGV generally involves antibiotics, such as azithromycin or doxycycline, which are given for several weeks to eradicate the bacteria. In severe cases, surgery may be necessary to remove affected lymph nodes or repair damage to the surrounding tissues.

It is essential to practice safe sex and to get tested for sexually transmitted infections regularly to reduce the risk of contracting LGV or other infections. If you have symptoms or suspect you may have been exposed to LGV, seek medical attention as soon as possible to get a proper diagnosis and prompt treatment.

Symptoms of Lymphogranuloma Venereum

Lymphogranuloma Venereum is can affect only men. It infects the genital area of men. It can spread from man to man, by means of sex between men. Patients with LGV may notice changes in the genital area. Symptoms can appear within 2 to 21 days after exposure to the bacteria. Symptoms include;

• Genital papules: The papule in LGV refers to a small, raised, and sometimes painful bump on the genital area. These papules are a common early symptom of LGV and can occur within days to weeks after exposure to the bacteria. They can be mistaken for genital warts or other skin conditions, but it is important to seek medical attention for proper diagnosis and treatment.
• Ulcers: One of the most common symptoms of LGV is the development of painful ulcers on or near the genital area. These ulcers can be painful, itchy, and swollen, and may also cause discharge and discomfort while urinating.
• Swelling of the lymph glands: Symptoms can include swollen lymph glands in the groin on one or both sides or an ulcer or sore on the penis, vagina or around the anus.

LGV may also produce other symptoms, especially among those who practice receptive anal intercourse:

• Rectal ulcers: Rectal ulcers are a common symptom of LGV, usually appearing a few days after initial infection. These ulcers can be painful and may cause discomfort during bowel movements.In some cases, rectal ulcers can lead to secondary infections or even rectal fistulas. It is important to seek medical attention as soon as possible if you suspect you have been infected with LGV.
• Bleeding: Bleeding in LGV is most commonly seen in advanced cases where there has been extensive tissue damage in the genital area. This can cause open wounds and ulcers which are susceptible to bleeding. Additionally, inflammation in the lymph nodes can cause increased pressure and result in bleeding from these nodes.
• Pain: Pain is a common symptom of LGV and can occur in different parts of the body, depending on the stage of the infection.In the early stage, the pain may be felt in the genital area, including the anus, scrotum, or vulva. This pain can be accompanied by itching, burning, and swelling. In some cases, there may also be discharge and small bumps or ulcers.In the second stage of LGV, the infection can spread to the lymph nodes, causing swelling, tenderness, and pain. The affected lymph nodes may become larger and more painful, and may eventually burst and cause abscesses.
• Discharge: In severe cases, LGV can cause a number of complications, including fistulas, abscesses, and scarring. Pain may be felt in the rectum, anus, or scrotum, and may be accompanied by a discharge.

Causes of Lymphogranuloma Venereum

Lymphogranuloma Venereum (LGV) is a sexually transmitted infection caused by the bacterium Chlamydia trachomatis. The infection is transmitted through sexual contact with an infected individual, including vaginal, anal, or oral sex. It can also be transmitted through skin-to-skin contact with infected areas, such as the genital or rectal region. The bacterium invades the lymphatic system and causes inflammation, leading to the symptoms of LGV. Poor hygiene, unprotected sexual contact and having multiple sexual partners increase the risk of contracting LGV. It is rare in women, but common in men, especially those who have sex with men. Other causes of LGV include:

1. Unprotected sexual activity: Having unprotected sexual intercourse with an infected partner increases the risk of LGV.
2. Multiple partners: Having multiple sexual partners increases the likelihood of exposure to LGV.
3. Anal sex: Anal sex is a higher risk activity for LGV because the tissues in the anus are more delicate and more likely to be exposed to the bacteria.
4. Fisting and Fingering: Fisting and fingering are not direct causes of LGV but can increase the risk of transmission if proper hygiene is not practised.
5. Poor hygiene: Poor hygiene practices such as not washing after sexual contact can increase the risk of LGV.

We should practise safe sex and get regular check-ups to prevent the spread of LGV and other sexually transmitted infections.

Risk Factors of Lymphogranuloma Venereum

Apart from the original cause and means to spread the infection, there are several factors that can increase the risk of having an LGV infection. These factors are as under;

1. Sexual behaviours: Having unprotected sex, having multiple sexual partners, and engaging in anal sex increase the risk of contracting Lymphogranuloma Venereum (LGV).
2. Geographic Factors: LGV is most common in tropical regions and areas with high rates of poverty and limited access to medical care.
3. HIV infection: People with HIV are more likely to develop LGV due to their weakened immune systems.
4. Poor hygiene: Poor hygiene practices can increase the likelihood of exposure to LGV.
5. Other STDs: People who have other sexually transmitted diseases, such as syphilis, chlamydia, or gonorrhoea, are more at risk for contracting LGV.
6. Age Factor: Young people who are sexually active are at a higher risk for LGV.
7. Non-compliance with medication: Failing to take medications as prescribed or not completing the full course of antibiotics can increase the risk of LGV.
8. Immune suppression: People with weakened immune systems, such as those undergoing chemotherapy, organ transplantation, or with autoimmune diseases, are more susceptible to LGV.

When to see a doctor in Lymphogranuloma Venereum

If you are experiencing symptoms such as genital pain, itching, ulcers, discharge, or swelling of the lymph nodes, you should seek medical attention. Additionally, if you have been sexually active and are experiencing these symptoms, it is important to inform your doctor of any recent sexual activity, to receive a proper diagnosis and treatment plan. Early diagnosis and treatment are essential to prevent complications and the spread of the infection.

Complications of Lymphogranuloma Venereum

Like other infections, LGV can also lead to several medical conditions, that become complicated while treating them. It is therefore advised to treat the infection at its early symptoms to prevent complications. There are several complications associated with LGV infection. The most common are as follows;

1. Rectal fistulas: Prolonged infection in the rectal area can lead to the formation of fistulas, which are abnormal connections between the rectum and other organs.
2. Genital ulceration: The affected areas can become severely ulcerated, leading to painful and persistent sores that are difficult to heal.
3. Scrotal swelling: The scrotum can become swollen and inflamed, leading to severe pain and discomfort.
4. Chronic pelvic pain: Prolonged infection can lead to chronic pelvic pain, which can be debilitating and impact daily life.
5. Inguinal adenopathy: Lymphogranuloma venereum can lead to inguinal adenopathy, which is the swelling of the lymph nodes in the groin area.
6. Anal strictures: The infection can lead to the formation of strictures in the anus, which can lead to difficulties with bowel movements.
7. Fertility problems: Infertility can occur in both men and women as a result of scarring from the infection.
8. Abscess formation: Abscesses can form in the affected areas, leading to severe pain and discomfort, as well as an increased risk of infection.
9. Septicemia: Lymphogranuloma venereum can lead to septicemia, which is a serious and potentially life-threatening bacterial infection of the bloodstream.

How to prevent Lymphogranuloma Venereum

By having safe sex and avoiding the risk factors, you can prevent having an infection of LGV.

1. Avoid unsafe Man-Man Sex: A LGV affects men more than women. Therefore, the chances of transmission of the infection are greater in men having anal sex with men. If an infected person has receptive anal intercourse, he can easily transmit the infection to the partner.
2. Use a Condom: The use of a condom during sexual activities can significantly reduce the risk of spreading Lymphogranuloma Venereum.
3. Get Tested Regularly: Regular testing for STDs can help detect Lymphogranuloma Venereum in its early stages, making treatment more effective.
4. Limit Sexual Partners: Reducing the number of sexual partners can lower the risk of exposure to Lymphogranuloma Venereum.
5. Avoid Unprotected Sex: Avoiding unprotected sex, particularly anal sex, can lower the risk of contracting Lymphogranuloma Venereum.
6. Get Vaccinated: A vaccine for Lymphogranuloma Venereum is not currently available, but getting vaccinated for other STDs, such as HPV, Hepatitis A, and Hepatitis B, can lower the overall risk of contracting Lymphogranuloma Venereum.
7. Practice Good Hygiene: Good hygiene practices, such as washing the genital area thoroughly after sex, can help reduce the risk of contracting Lymphogranuloma Venereum.

Diagnosis of Lymphogranuloma Venereum

The diagnosis of Lymphogranuloma Venereum (LGV) is made through a combination of clinical symptoms, medical history, and laboratory tests.

Clinical symptoms: Patients with LGV present with symptoms such as painful genital ulcers, inguinal lymphadenopathy, and rectal pain.

Medical history: The doctor will ask about the patient’s sexual history, including any recent sexual partners, unprotected sexual contact, or travel to areas where LGV is common.

Laboratory tests: The diagnosis of LGV is confirmed by laboratory tests such as:

1. Polymerase chain reaction (PCR) test: This test is used to detect the presence of Chlamydia trachomatis, the bacterium that causes LGV, in genital secretions or lymph node aspirates.
2. Serology tests: Blood tests can be performed to detect antibodies against Chlamydia trachomatis, which indicates a previous or current LGV infection.
3. Culture tests: The doctor may perform a culture test to grow the bacteria and confirm the diagnosis.

Treatment of Lymphogranuloma Venereum

Lymphogranuloma Venereum (LGV) is caused by the bacterium Chlamydia trachomatis. It is, therefore, treated with doses of antibiotics. The recommended treatment for LGV is:

1. Azithromycin: A single dose of azithromycin is usually prescribed for LGV. This is a macrolide antibiotic that works by stopping the growth of bacteria.
2. Doxycycline: Doxycycline is a tetracycline antibiotic that is taken orally for 14 days. This medication is effective against LGV and helps prevent the spread of the infection.
3. Erythromycin: Erythromycin is another macrolide antibiotic that is used to treat LGV. It is taken orally for 14 days.

It is essential to take the full course of antibiotics prescribed by your doctor to ensure that the infection is completely treated. If symptoms persist after treatment, it is important to return to your doctor for further evaluation.

Note: It is also recommended to avoid sexual contact until the infection has been treated and all symptoms have resolved. This helps prevent the spread of LGV to others.