Lymphogranuloma venereum

Background

• Infection caused by Chlamydia trachomatis serovars L1, L2 and L3
• Transmitted sexually through vaginal, anal, or oral contact

Epidemiology

• Uncommon in Canada but more common in parts of Africa, Asia, South America, and the Caribbean
• Occasional outbreaks among men who have sex with men

Clinical Manifestations

Primary LGV

• Incubation period 3 to 30 days
• Starts with small painless papule at site of inoculation that may ulcerate
• Only noticed in 50% of patients

Secondary LGV

• Latency of 2 to 6 weeks from primary lesion
• Presents with systemic symptoms, including fevers and chills, malaise, myalgias, and arthralgias
• May have abscess with or without draining sinuses
• Occasionally involves arthritis, pneumonitis, hepatitis, and rarely involves carditis, aseptic meningitis, or ocular inflammation

Secondary LGV with lymphadenopathy

• Most commonly involves painful inguinal or femoral lymphadenopathy, called "buboes"
• The "groove sign", where nodes are seen above and below the inguinal ligament, is highly specific for LGV

Secondary LGV with anorectal symptoms

• Presents with acute hemorrhagic proctitis
• May also cause constipation

Tertiary LGV

• Also called chronic LGV, and occurs in 10 to 20% of untreated patients
• Characterized by chronic inflammation that causes:
  • Lymphadtic obstruction leading to genital elephantiasis
  • Genital and rectal strictures and fistulae
• Can cause esthiomene, extensive destruction of genitalia

Investigations

• Anoscopy/sigmoidoscopy/proctoscopy
  • Similar appearance to ulcerative colitis
• Bubo aspiration
  • Usually contains small amount of milky fluid
  • Aspirate through healthy skin

Prevention

• Consistent use of condoms or other barrier methods, including for oral sex
• Avoid mucosal trauma if possible