What Is Lymphogranuloma Venereum (LGV)?

Lymphogranuloma venereum (LGV) is a type of sexually transmitted infection (STI) caused by Chlamydia trachomatis (C. trachomatis) bacteria. LGV can cause proctitis, or inflammation of the rectal lining, and is particularly common in people with human immunodeficiency virus (HIV).

If left untreated, LGV can cause long-term damage to the genital area. The infection is typically treated with antibiotics.

LGV is rare in the U.S., but there have been occasional outbreaks over the past few decades—particularly among men who have sex with other men.

Here's everything you need to know about lymphogranuloma venereum, including symptoms, causes, risk factors, and treatment options.

Lymphogranuloma Venereum Symptoms

Lymphogranuloma venereum is sometimes asymptomatic, meaning it might not cause any symptoms. If symptoms do occur, they typically appear in three stages.

The earlier symptoms from the first stage of LGV are more apparent among men. Women may only realize they have signs of LGV after developing complications from later stages of the disease.

First Stage

The first symptom of LGV is the development of a small, painless bump that is either filled with pus (pustule) or not (papule). This usually occurs within 3-30 days of exposure to the bacteria. Sometimes the bump might develop into an ulcer, or sore. The bump usually appears on the cervix, urethra, vagina, or rectum and goes away on its own after about a week. In the meantime, you might have discharge that is a mix of mucus and pus from your rectum, urethra, or cervix. 

In the second half of the first stage, lymphogranuloma venereum may progress into proctitis. The rectal inflammation makes it so that LGV symptoms are similar to those of inflammatory bowel disease (IBD). Symptoms during this phase of LGV infection may include:

• Rectal pain
• Bleeding from the rectum
• Painful bowel movements
• The feeling of needing to have a bowel movement but being unable to go (tenesmus)
• Abdominal pain
• Mucus in the stool

Second Stage

During the second stage of lymphogranuloma venereum, symptoms can become systemic, meaning they affect your whole body. You may experience the following symptoms:

• Fever
• Swollen genitalia 
• Swollen lymph nodes in the groin, rectum, neck, or armpits
• Severely swollen lymph nodes that may go up and down in size and rupture
• Arthritis
• Lung inflammation (pneumonitis)
• Swelling of the lining in the stomach and surrounding the liver (perihepatitis)

Third Stage

During the third stage of lymphogranuloma venereum, you may experience severe health complications, such as:

• Genito-anorectal syndrome, which involves chronic inflammation of the affected area(s) 
• Brain inflammation (encephalitis)
• Severe swelling of the genitalia (elephantiasis)
• Abnormal connections between the vagina and rectum (fistulae)
• Narrowing of the anal opening (anal strictures)
• Inflammation or infection in the eyes, joints, or vital organs
• Scarring of the genitals or rectum

What Causes Lymphogranuloma Venereum?

Lymphogranuloma venereum can be contracted through vaginal, anal, or oral sex with a person who has the infection. Unprotected sex carries a higher transmission risk.

LGV infection is caused by L1, L2, and L3 serovars (variations) of C. trachomatis bacteria. These are not the same strains of C. trachomatis bacteria that cause genital chlamydia.

Typically, the bacteria infect the lymphatic system, which is why LGV often leads to swollen lymph nodes.

Risk Factors

Anyone who is sexually active can get lymphogranuloma venereum. However, you may have a higher chance of developing LGV if you:

• Are a man who has sex with other men
• Are between the ages of 15-40 and sexually active
• Have HIV
• Have multiple sexual partners
• Often have unprotected sex with people you don’t know well
• Often engage in certain sex acts, such as anal sex
  

Where you live can also factor in to how likely you are to get LGV. The infection is more common in tropical and subtropical regions. For instance, lymphogranuloma venereum is more common in Central and South America than North America.

How Is Lymphogranuloma Venereum Diagnosed?

Lymphogranuloma venereum can sometimes be hard to diagnose. Blood tests can differentiate LGV from other kinds of STIs, but they are not available everywhere. Even if a test is available near you, the test results might not come back in a timely manner.

Instead, LGV is usually diagnosed through a physical examination of the affected area and information about your sexual history and symptoms. Your healthcare provider may also take specimens from your genital lesions, throat, rectum, or lymph nodes to check for what type of bacteria may be causing your symptoms.

Once a lymphogranuloma venereum diagnosis is confirmed, your healthcare provider may test you for other STIs, particularly HIV, gonorrhea, and syphilis.

Stages of Lymphogranuloma Venereum

There are three stages of LGV. Each stage brings on different symptoms:

• Primary stage: This stage starts 3-30 days after infection. It most commonly causes a painless bump or ulcer on the penis, vulva, cervix, or vaginal wall.
• Secondary stage: About two to six weeks after the lesion develops, you enter the second stage of LGV. During this time, the infection spreads so that it impacts your lymph nodes.
• Tertiary stage: If your LGV is untreated, it can develop into the third stage. Because most women with LGV don't experience early symptoms and so don't know to get treatment, this stage is more commonly experienced by women. During this stage, there is chronic inflammation and destruction of tissue.

Treatments for Lymphogranuloma Venereum

The goal of treatment is to clear the infection. The first-line treatment of choice for lymphogranuloma venereum is a course of antibiotics. 

If you are diagnosed with LGV, your healthcare provider will most likely prescribe Vibramycin (doxycycline) and instruct you to take it twice a day for three weeks. If you are pregnant or cannot take doxycycline for another reason, you may be prescribed a different antibiotic, like Zithromax (azithromycin) or Erythrocin (erythromycin), for three weeks. You may need to take antibiotics for a longer period if you have LGV complications.

Your healthcare provider may want you to follow up with them for several months to ensure your symptoms have subsided. They may recommend a follow-up test after three months to confirm the infection has cleared.

How To Prevent Lymphogranuloma Venereum

The only guaranteed way to prevent LGV or any other STI is to avoid sexual contact. If you are sexually active, using condoms during oral, vaginal, and anal sex can help to reduce your risk. 

If you had sex with someone with LGV in the past 60 days, you should go to a healthcare provider for evaluation and testing as a precaution. Even if you don't have any symptoms to confirm a diagnosis, they might prescribe you oral doxycycline, 100 milligrams, two times a day for a week as a way to reduce any chance of LGV complications if you do wind up having or soon developing it.

Complications

If your LGV is treated, you can have a complete recovery. But sometimes LGV can cause complications—especially if you receive treatment at a later stage. The complications may even last for years after you were first infected.

The following are potential complications from LGV:

• Fistula
• Infections in the joints, eyes, heart, or liver
• Long-term inflammation and swelling of the genitals
• Scarring and narrowing of the rectum
• Encephalitis (very rare)
  

A Quick Review

Lymphogranuloma venereum (LGV) is a sexually transmitted infection that affects the genital area, specifically the lymph nodes of that area. It can lead to symptoms like rectal pain, bloody stools, swollen genitalia, stomach pain, swollen lymph nodes, and constipation. If left untreated, LGV can cause complications like long-term damage to the tissues in the affected area. 

Because early symptoms more commonly show in men, LGV is often diagnosed in men earlier and diagnosed in women at later stages—when complications are likelier. A diagnosis is usually made based on symptoms and sexual health history. When it's diagnosed, lymphogranuloma venereum is treated with antibiotics. If treated promptly, LGV usually has a good outlook.