Lymphogranuloma

Complications of Lymplhogranuloma Venereum (LGV)

Lymphogranuloma venereum (LGV) primarily affects the skin and lymphatic tissue of the groin, but sometimes it can become systemic, affecting the body's organs and blood stream. The condition is caused by a form of Chlamydia trachomatis, an organism similar to the one that causes chlamydia infection. LGV occurs sporadically in the U.S., but is an endemic in many regions of the developing world. In North America and Europe, there was a recent outbreak of LGV proctocolitis (infection of the distal colon and prostate gland) among homosexual men. When the disease is allowed to progress, LGV can result in serious and permanent complications, such as genital deformity, rectal fistulas, rectal strictures, and permanent skin discoloration. Other complications include long-term inflammation of the genitals, brain inflammation, infection of the joints, heart, liver, or eyes, and scarring or narrowing of the rectum. Women who are not treated can develop an abnormal connection between the vagina and rectum.

Overview of LGV

LGV is a long-term infection of the lymphatic system that can occur from one of three types of the C. trachomatis bacteria. The microorganisms spread through sexual contact, and the infection is more common in Central and South America. Men who have sex with men and those who are HIV-positive are more commonly affected.

Causes and Risk Factors

LGV is caused by C. trachomatis, intracellular bacteria that lives within the human cells. The disease is transmitted during sex through small skin or mucous membrane tears. Once inside the skin, the pathogen enters the lymph nodes and causes swelling and pain. When the infection spreads to surrounding tissue around the lymph nodes, it can lead to a serious infection. Risk factors for LGV include:

  • Visiting endemic regions.
  • Living in a third world country.
  • Engaging in anal intercourse.
  • Having multiple sex partners.

Incidence and Prevalence

LGV is rare in America, but is most common in Africa, Southeast Asia, Central America, and the Caribbean. It accounts for around 10 percent of the genital ulcer in India and Africa. It is more common in men than women, and blacks are more affected than other races. The peak age range for LGV is 15 to 40 years.

Signs and Symptoms of LGV

LGV is a chronic and progressive disease that is characterized by three stages, each with a different set of signs and symptoms. These include:

  • Primary. With the primary stage of LGV, the infected person has non-painful papules, erosions, or ulcers that occur after three to 12 days from exposure. The lesion typically is so small that it is not considered a problem.
  • Secondary. The secondary stage of LGV causes many symptoms, as the infection spreads to the lymphatic tissue and surrounding skin. Many people also have swollen lymph nodes in the groin area (inguinal lymphadenopathy). Associated symptoms include fever, fatigue, muscle aches, joint pains, and chills.
  • Tertiary. During the tertiary stage, untreated people develop chronic inflammatory conditions, such as fistulas, strictures, stenosis, and lymphedema (red, swollen skin). Other symptoms include pain, fever, purulent and/or bloody diarrhea, and penile or vaginal discharge.

Diagnosis and Treatment

To diagnose LGV, the doctor may do a culture test for chlamydia, a blood test for the presence of the causative organisms, and/or a biopsy of the lymph node. The treatment of choice for LGV is the antibiotic doxycycline, but azithromycin is also effective. For symptomatic treatment, nonsteroidal anti-inflammatory drugs (NSAIDS) and local cold compresses can offer some benefit. If left untreated and complications arise, surgery is often necessary to repair fistulas, stenosis, and strictures.

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