Lymphogranuloma Venereum LGV

 Lymphogranuloma venereum (LGV), also known as lymphopatia venereal, tropical bubo, climatic bubo, strumous bubo, poradenitis inguinales, Durand-Nicolas-Favre disease and lymphogranuloma inguinale, is an uncommon sexually transmitted disease that primarily infects the lymphatics.  LGV was originally described in 1833 by Wallace. It was defined as a clinical and pathological entity in 1913 by Durand, Nicolas, and Favre. LGV is caused by an obligate intracellular bacterium, Chlamydia trachomatis. There are 15 known serotypes of Chlamydia trachomatis, but only serotypes L1, L2 and L3 cause LGV.

In the US, LGV rates are not known because it is not a reported sexually transmitted disease. Nevertheless between November 2004 and January 2006, LGV was identified in 180 specimens, with 27 identified as obtained from homosexual males.

LGV is an uncommon disease. It is most commonly found in areas of the Caribbean, Central America, Southeast Asia, and Africa. In Europe it is rare, only in the Netherlands 92 cases have been identified between 2003 and 2004.

LGV is an STD and probably affects both sexes equally, although it is more commonly seen in men. LGV may affect any age but has a peak incidence in the sexually active population aged 15-40 years.

LGV has an incubation period ranging from 3 to 30 days after contact with an infected person. 

SIGNS AND SYMPTOMS 

LGV occurs in 3 stages:

The first one appears after 3-30 days after the inoculation and is characterized by a small, painless papule or pustule that may erode to form a small, asymptomatic herpetiform ulcer that usually heals rapidly without scarring. In men, the primary infection can appear on the coronal sulcus, prepuce, glans, and scrotum. In women, the most common sites of infection include the posterior vaginal wall, posterior cervix, fourchette, and vulva.

The secondary stage begins 2-6 weeks after the primary lesion. The symptoms include painful regional lymphadenopathy (usually in the inguinal and/or femoral lymph nodes); painful, swollen lymph nodes coalesce to form buboes, which may rupture in as many as one third of patients. Those that do not rupture harden, then slowly resolve. In women the infection may involve the deep iliac or perirectal nodes and may only experience a nonspecific back and/or abdominal pain. This is the stage when most men are diagnosed. Other symptoms include fever, chills, myalgias (muscular pain or tenderness, especially when diffuse and non-specific), and malaise.

The third stage (genitoanorectal syndrome) is more common in women, secondary to their lack of symptoms during the first two stages. This stage is characterized by proctocolitis (irritation of the colon and rectum). Symptoms of this stage include malaise, weight loss, bloody purulent discharge, fever, rectal pain, tenesmus (straining to have a bowel movement). 

TREATMENT 

Treatment consists of oral antibiotics (Doxycycline, Tetracycline and Erythromycin) and drainage of infected buboes. There are no restrictions for physical activities. 

COMPLICATIONS 

Lymphatic obstruction ends in genital elephantiasis or esthiomene.

Bubo rupture may lead to fistulas and sinus tracts. This complication typically occurs during the first stage (primary LGV) of infection. Proctocolitis may lead to fissures, fistulas, abscess, scarring, and strictures.

PREVENTION 

In order to avoid contracting STDs like LGV and others you must use the condom every time you have sex or avoid sexual intercourse with high-risk sexual partners. 

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