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Lymphogranuloma venereum

What is lymphogranuloma venereum?

Lymphogranuloma venereum is a sexually transmitted disease (STD) caused by specific strains of the bacteria Chlamydia trachomatis. It is rare in New Zealand. It has several features. Firstly, small painless ulcers may appear on the genitals but often go unnoticed as they heal quickly. Most people seek care weeks later when painful and swollen lymph glands develop around the groin region. Complications occur such as abcesses or fistulas occur when the infection becomes deep-seated.

Who is at risk of lymphogranuloma venereum?

Sexually active people may be at risk of getting lymphogranuloma venereum. It is most commonly found in tropical or subtropical areas of the world such as Southeast Asia, the Caribbean, Central America and Africa. In countries where it is less frequently seen, cases are most often contracted overseas. It is significantly more common in men than women. The peak incidence is in persons 15 to 40 years old.

What are the signs and symptoms of lymphogranuloma venereum?

Once infected there is an incubation period of anywhere from 3 days to 6 weeks (on average 10-14 days) before any signs or symptoms become apparent.

Stage	Features
1	Small painless papule appears. Ulcerates, heals and disappears within a few days and may go unnoticed.
2	Most male patients present during this stage About 2-6 weeks after the 1st stage painful and swollen lymph glands (buboes) develop on one (most common) or both sides of the groin. Women may present with lower abdominal or back pain (deep pelvic node involvement). Other symptoms include malaise, fever, chills, joint and muscular pain and vomiting.
3	Most female patients present during this stage with fever, pain, itch, pain on passing stools and urinating, and pus-filled or bloody diarrhoea. Chronic inflammation may lead to abscesses, fistulas, lymphatic obstruction, rectal strictures and proctocolitis. Chronic infection may result in severe scarring causing major deformation of the genitals.

Laboratory tests for Lymphogranuloma venereum

The main method of diagnosis is using an antibody blood test (complement fixation titers of >1:64) and excluding other causes of swollen lymph glands or genital ulcers.

What is the treatment for lymphogranuloma venereum?

Lymphogranuloma venereum is treated with antibiotics to cure the infection and prevent ongoing tissue damage. Treatment with erythromycin or doxycycline for at least 3 weeks is required. Azithromycin has also been used. If necessary, large swollen lymph glands (buboes) may be drained. Surgery to repair fistulas and strictures may also be required.

All sexual activity should be refrained from until the condition has been treated successfully. Patients should be followed-up until all signs and symptoms of the infection have resolved.

Can lymphogranuloma venereum be prevented?

As with other STDs, if you think you are infected, stop all sexual contact and see your doctor or STD clinic immediately. Safe-sex practices will prevent the spread of lymphogranuloma venereum as well as other STDs.

Related information

Books:

See the DermNet NZ bookstore

On DermNet NZ:

Other websites:

Auckland Sexual Health Services
CDC STD treatment guidelines 2002
Lymphogranuloma venereum – emedicine dermatology, the online textbook

Author: Vanessa Ngan, staff writer