Lymphogranuloma Venereum

Lymphogranuloma Venereum is a topic covered in the 5-Minute Clinical Consult.

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Basics

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).

Description

  • 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]

Epidemiology

  • Predominant age: 15 to 40 years; peak sexual activity
  • Predominant sex: males

Incidence
Variable with more recent outbreaks in the United States and especially Europe (2)[B]

Prevalence
Increasing in the United States and Europe, especially with MSM and the HIV-positive populations; an underreported and undertested STI (1)

Pregnancy Considerations
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].

Risk Factors

  • HIV positive (particularly HIV-positive MSM) (4)
  • Unprotected intercourse
  • Multiple sexual partners
  • Anal intercourse (4)
  • Residing in tropics or Europe (2)
  • Uncircumcised penis

General Prevention

Condoms may provide some protection against genital–anogenital transmission but have no impact on transmission between other sites (1)[C].

Commonly Associated Conditions

HIV, gonorrhea, chlamydia (cervicitis, urethritis) hepatitis B, hepatitis C, herpes simplex virus, syphilis

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Citation

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TY - ELEC T1 - Lymphogranuloma Venereum ID - 816025 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816025/all/Lymphogranuloma_Venereum PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -