Lymphogranuloma Venereum (LGV): Symptoms, Causes, Treatment - Verywell Health

Lymphogranuloma venereum (LGV) is a curable sexually transmitted infection (STI) caused by subtypes of Chlamydia trachomatis (the bacteria that causes chlamydia). LGV can be passed through anal, vaginal, or oral sex and progresses in three distinct stages.

Early symptoms of LGV include painless bumps or ulcers that are sometimes mistaken for syphilis or genital herpes. Though easily treated with antibiotics, untreated LGV infections can lead to potentially severe complications, including ruptured lymph nodes or anal fistulas.

This article looks at the causes and symptoms of lymphogranuloma venereum, including how this uncommon STI is diagnosed and treated. It also describes the risk factors for LGV and what you can do to reduce your odds of infection.

Israel Sebastian / Getty Images

Gender Definition

For the purpose of this article, "male" refers to people born with penises and "female" refers to people born with vaginas without regard to the gender or genders they identify with. The gender terms used in this article reflect those used in the cited sources.

What Causes Lymphogranuloma Venereum (LGV)?

Chlamydia is the most common bacterial STI in the United States. It is caused by different variations (serovars) of the Chlamydia trachomatis. Of the 19 known serovars, four uncommon ones—L1, L2, L2a, and L3—cause a distinct STI known as lymphogranuloma venereum.

LGV differs from non-LGV chlamydia in that it primarily affects the lymphatic system (the group of organs, tissue, and fluids that helps the body fight infection). By contrast, chlamydia is mainly confined to mucosal tissues at the site of the infection (including the genitals, rectum, and urinary tract).

LGV is transmitted (spread) through condomless anal, vaginal, and oral sex. The bacterium is found in body fluids such as semen, pre-ejaculate ("pre-cum"), vaginal fluids, and anal fluids.

When a person acquires LGV, the bacteria will migrate from the site of the infection to nearby lymph nodes, where it quickly multiplies and triggers an inflammatory reaction. Symptoms develop as the lymph nodes sustain progressive injury.

Who Might Get LGV? 

LGV is endemic (constantly present) in South and West Africa, India, Southeast Asia, and the Caribbean. It also affects countries in other areas with occasional clusters and outbreaks. The last known LGV cluster in the United States occurred in Michigan and Illinois from 2015 to 2016.

LGV can affect anyone of any age, but sexually active people between 15 and 40 are at the greatest risk. People of all sexes may acquire LGV. But in Europe and North America, it is most often seen in men who have sex with men (MSM) who have human immunodeficiency virus (HIV).

Research from the Centers for Disease Control and Prevention (CDC) suggests a rapid increase in LGV diagnoses among MSM who have HIV. All 38 cases of LGV confirmed in the 2015–2016 cluster were among HIV-positive MSM.

LGV in Men Who Have Sex With Men

For reasons unknown, rectal LGV infections among men who have sex with men (MSM) are 15 times more common than genital LGV infections in MSM.

LGV Symptoms

LGV occurs in three distinct stages as the bacterium progressively injures and, in some cases, permanently damages lymph nodes.

Primary Stage

The primary stage is characterized by the infection of cells and tissues at the site of the exposure. The incubation period (the time between exposure and the appearance of symptoms) is usually between three and 12 days but can be as long as 30 days.

During the primary infection, small, painless lesions will develop on the skin at the site of the exposure. The lesions may appear as papules (bumps), pustules (pimple-like blisters), or shallow ulcers.

Because the lesions are painless and short-lived, they may go entirely unnoticed, particularly if they occur in the mouth, vagina, or anus. Most primary LGV lesions clear within a few days.

Asymptomatic LGV

Some early cases of LGV are asymptomatic (meaning without symptoms) and may only cause symptoms when the disease is advanced. Some studies suggest that 1 n 4 MSM with LGV are asymptomatic.

Secondary Stage

The secondary stage is when LGV has moved from the site of exposure to nearby lymph nodes, typically two to six weeks after the primary stage.

Secondary LGV typically causes painful, swollen lymph glands, also known as buboes, in the groin area (inguinal lymphadenopathy or femoral lymphadenopathy). One or both sides of the body may be affected. In some cases, the buboes will cause large, visible lumps under the skin.

If LGV infection occurs in the mouth or throat, there may be swelling of the lymph nodes of the neck (cervical lymphadenopathy).

Other symptoms may include:

• Anal and rectal pain
• Rectal discharge
• Rectal bleeding
  
• Tenesmus (feeling like you need to poop even if the bowel is empty)
• Constipation
• Pelvis or groin pain (more often in females)
  
• Flu-like symptoms (such as fever, chills, joint aches, difficulty breathing, cough)

Late Stage

The late stage, also known as late sequelae, can develop if LGV is left untreated. Prolonged LGV infection can cause fibrosis (the scarring and thickening of tissues), adhesions (the sticking together of tissues), and necrosis (tissue death) in both the lymph nodes and surrounding tissues.

This can lead to late-stage complications like:

How Is LGV Diagnosed?

If LGV is suspected based on clinical signs (such as bloody rectal discharge, tenesmus, and rectal ulcers), a test called a nucleic acid amplification test (NAAT) can be used. This test is able to detect all serovars of Chlamydia trachomatis based on a swab of genital, rectal, or oral lesions or by obtaining fluids from a swollen or ruptured lymph node.

Differential Diagnosis

To help confirm the diagnosis, additional tests may be performed to exclude diseases with similar symptoms, such as:

Partner Notification

Sexual partners should also be tested and treated. LGV is a nationally notifiable condition, meaning that sexual partners would be informed of your diagnosis by public health officials to prevent further spread of infection.

How Is LGV Treated?

LGV is curable at any stage of infection with antibiotics. Ideally, treatment should be administered at the earliest stage of infection to avoid complications.

There are three antibiotics that can be used, each of which is taken by mouth:

 	 Antibiotic	 Dosage
Preferred option:	Doxycycline	100 milligrams twice daily for 21 days
Alternative options:	Azithromycin	1 gram once weekly for three weeks
 	Erythromycin	500 milligrams four times daily for 21 days 

Doxycycline is the preferred option because it has a cure rate of over 98.5%.

Whichever antibiotic is used, it is important to take it as prescribed and to completion. Skipping doses or stopping treatment early increases the risk of antibiotic resistance, making the infection harder to treat if it returns.

LGV Complications

Some people experience rare but serious complications of LGV. Some of these are caused when Chlamydia trachomatis disseminates (spreads through the bloodstream) and affects distant organs. Others are inflammatory reactions to the infection or severe forms of late-stage symptoms.

Serious complications include:

How to Reduce Your Risk of LGV

You can reduce the odds of getting LGV in the same ways as with chlamydia, gonorrhea, and other STIs. It all starts with practicing safer sex.

This includes:

What's the Outlook for Someone With LGV?

The prognosis (outlook) of LPV is generally good if you get treated in a timely manner. The general rule of thumb is the earlier, the better.

Timing can be complicated if you are initially asymptomatic, as certain complications, such as ruptured buboes, can develop quite early and cause permanent scarring. At other times, LGV may be mistaken for other conditions and left untreated until potentially serious (and irreversible) complications like infertility occur.

This is why it is important to keep on top of recommended STI screenings if you are at an increased risk of STIs. This includes sexually active MSM and females under 25. These groups of people are advised to undergo annual chlamydia screening.

How Long Is LGV Contagious?

LGV is considered contagious until the infection is fully cleared with antibiotics. The same applies to asymptomatic people who still have Chlamydia trachomatis in their semen, vaginal secretions, and anal secretions.

Despite the high cure rate with antibiotics like doxycycline, the CDC recommends follow-up testing three months after the completion of treatment just to be sure that you are in the clear or have not been reinfected.

LGV Reinfection

Even if you've been cured of LGV, you can get it again. This is why it's important to maintain safer sex practices after treatment is complete.

According to the American Sexual Health Association, around 1 in 5 people treated for chlamydia in the United States will be reinfected within the first few months.

Summary

Lymphogranuloma venereum (LGV) is a curable STI caused by four subtypes of Chlamydia trachomatis. LGV is relatively rare in the United States, although occasional outbreaks can occur, mostly among HIV-positive men who have sex with men. Even so, anyone of any age can get LGV through anal, vaginal, and oral sex.

LGV develops in stages, causing lesions at the site of the exposure before moving to lymph nodes, where they cause pain, swelling, and other symptoms. LGV can be diagnosed with a swab of lesions and successfully treated with a course of antibiotics. Consistent condom use and a reduction in the number of sex partners can substantially lower the risk of LGV.

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