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Lymphogranuloma venereum (LGV) is an uncommon systemic sexually transmitted infection (STI) caused by Chlamydia trachomatis. The incidence of LGV continues to increase in Europe, especially among men having sex with men (MSM).
- Initially presents as painless, anogenital, vesicular, or ulcerative lesions followed by tender inguinal/femoral lymphadenopathy. If untreated, proctocolitis can occur causing severe inflammation and scarring; mistaken diagnosis as inflammatory bowel disease can occur (1).
- Historically classified as a disease of the tropics and rare in developed countries, but outbreaks have been reported in Europe, North America, and Australia with especially increasing prevalence in Europe among MSM population (2)
- System(s) affected: lymphatic, immunologic, hematologic, gastrointestinal, reproductive
- Synonym(s): tropical bubo; climatic bubo; Durand–Nicolas–Favre disease; lymphogranuloma inguinale; fourth, fifth, or sixth venereal disease (1)[C]
- Predominant age: 15 to 40 years; peak sexual activity
- Predominant sex: males
Increasing in the United States and Europe, especially with MSM and the HIV-positive populations; an underreported and undertested STI (1)
May be acquired perinatally from the birth canal; congenital transmission is not known to occur.
Etiology and Pathophysiology
- 3 of the 15 known strains of C. trachomatis, (serovars L1, L2, L3) cause LGV. Strains of C. trachomatis that cause urethritis infect only squamocolumnar cells; LGV strains are more invasive, replicate in macrophages, and can spread to lymphatic tissue at the site of infection, leading to systemic illness. The L2 serovar is particularly virulent and becoming more prevalent in Europe (3)[B].
- Tissue damage occurs from lymphatic inflammation and obstruction (1)[C].
Commonly Associated Conditions
HIV, gonorrhea, chlamydia (cervicitis, urethritis) hepatitis B, hepatitis C, herpes simplex virus, syphilis