Sexually Transmitted Infections: Lymphogranuloma Venereum

Introduction

• Description: Lymphogranuloma venereum (LVG) is a potentially destructive infection caused by a number of serotypes (L-1, L-2, L-3) of Chlamydia trachomatis. Although uncommon in the United States, this infection causes significant morbidity.

• Prevalence: Uncommon; <100 cases per year in the United States; endemic in parts of Africa, India, Southeast Asia, South America, and the Caribbean.

• Predominant Age: Younger reproductive age.

• Genetics: LVG is 20 times more common in men than in women.

Etiology and Pathogenesis

• Causes: LGV is caused by several serotypes of C. trachomatis.

• Risk Factors: Sexual trauma and exposure to the infective agent.

Signs and Symptoms

• Painless vesicle that quickly heals leaving no scar (3–12 days), generally located on the posterior aspect of the vulva or vestibule.

• Proctitis, tenesmus, or bloody rectal discharge in anorectal infections (anal intercourse).

• Progressive adenopathy with bubo formation (groove sign—the “groove sign” is not specific to LGV; it may also be seen in other inflammatory processes such as acne inversa).

• Severe fibrosis and scarring (elephantiasis, “esthiomene,” rectal stenosis may occur).

Diagnostic Approach