Lymphogranuloma venereum

Causes and Risks:
Lymphogranuloma venereum (LVG) is caused by three subtypes of Chlamydia trachomatis and is separate from the types that cause eye disease, blindness and the more common genital chlamydia.

Lymphogranuloma venereum is more common in Central and South America than in North America. LVG has a variable incubation period ranging from a few days to a month.

It begins as a painless ulcer on the male genitalia or in the female genital tract. As the organism spreads, the inguinal lymph nodes swell, become tender and attached to the surrounding tissue (fixed), and finally rupture and drain through the skin. The skin above the lymph node is often swollen (edematous) and red. These areas may appear to heal, but the patient will have relapses of lymph node swelling and drainage. The patient may also have systemic signs including fever , decreased appetite , and malaise .

In homosexual men and women who practice anal intercourse the disease produces lymph node swelling around the rectum (perirectal). This is often accompanied by bloody rectal discharge, painful defecation ( tenesmus ), diarrhea and lower abdominal pain . Women may develop fistulas between the vagina and rectum.

Prevention:
Abstinence is the only absolute answer to preventing sexually transmitted disease. Safer sex behaviors may reduce the risk. A monogamous sexual relationship with a person known to be free of any STD is adviseable. The use of condoms , both male and female types, markedly decrease the likelihood of contracting a sexually-transmitted disease but must be used properly. The condom should be in place from the beginning to end of sexual activity and should be used EVERY time the person engages in sexual activity with a non-monogamous partner or other suspect partner. Condoms are effective and inexpensive considering the consequences of contracting a sexually transmitted disease.

Symptoms:
  • pain while having a bowel movement ( tenesmus )
  • small painless ulcer on genitalia
  • swollen groin (inguinal) lymph nodes on one or both sides
  • drainage from inguinal lymph nodes
  • swelling and redness of the skin over the inguinal lymph nodes
  • drainage of blood or pus from the rectum ( blood in the stools )



Signs and Tests:
The medical history and physical examination may show:

  • a history of sexual contact with a person having lymphogranuloma venereum
  • an ulcer on an affected woman's vaginal wall
  • an ulcer on an affected woman's cervix
  • a perianal fistula with drainage
  • inguinal lymph node enlargement (inguinal lymphadenopathy )
  • suppuration and drainage of inguinal lymph nodes

Tests:

This disease may also change the results of:



Treatment:
Lymphogranuloma venereum can be cured by proper antibiotic therapy. Commonly prescribed medications include:

  • tetracycline, 500 mg (milligrams) by mouth, four times per day for 3 weeks
  • doxycycline, 100 mg by mouth, twice a day for 3 weeks
  • sulfisoxazole, 500 mg by mouth, four times per day for 3 weeks
  • erythromycin, 500 mg by mouth, four times per day for 3 weeks

Note: Oral tetracycline is usually not prescribed for children until after all the permanent teeth have erupted; it can permanently discolor teeth that are still forming.

Prognosis:
Recovery and a shorter course of illness is expected with treatment.

Complications:

  • rectal stricture (scarring and narrowing of the rectum)
  • elephantiasis of the genitalia (enlargement and chronic inflammation)
  • rectovaginal fistula (an opening between the rectum and vagina )
  • meningoencephalitis (brain inflammation)



Call Your Healthcare Provider:
Call your health care provider if you suspect you have been exposed to lymphogranuloma venereum or you have symptoms suggestive of LVG.


Lymphogranuloma venereum is a sexually transmitted disease that causes ulcers on the genitalia and enlargement, drainage, and scarring of the inguinal lymph nodes and rectal lymph nodes. Scarring and rectal obstruction may result from this disease. This photograph demonstrates the inguinal lymph node enlargement and erosion to the surface on the patient's left side (seen on the right side of the picture).



Lymphogranuloma venereum - view of penile lesion: Lymphogranuloma venereum is a sexually transmitted disease that causes ulcers on the genitalia and enlargement, drainage, and scarring of the inguinal lymph nodes and rectal lymph nodes. Permanent scarring and/or rectal obstruction may result from this disease. This photograph demonstrates ulceration on the penis.