Excerpt from Lymphogranuloma Venereum

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Background

Lymphogranuloma venereum (LGV) is a sexually transmitted chlamydial disease that should be a part of the differential diagnosis for any patient presenting with a genital ulcer and/or inguinal lymphadenopathy. Treatment involves the use of antibiotics to clear the infection and to prevent tertiary sequelae. The disease is an important emerging sexually transmitted disease among men who have sex with men.

Pathophysiology

Chlamydia trachomatis, an obligate intracellular organism, is the causative agent, and serotypes L1, L2, and L3 have been associated with infection. While other serotypes of C trachomatis are limited to superficial infection of mucous membranes, serotypes L1, L2, and L3 are more invasive and virulent, tending to result in systemic disease. The organism travels through the lymphatics to multiply within macrophages in regional lymph nodes. Characterization of the rate of transmission or the reservoir of C trachomatis has not been defined clearly, although asymptomatic women are believed to be a source of infection.

LGV occurs in 3 stages, the first of which has an incubation period of anywhere from 3 days to 6 weeks (10-14 d average) and is characterized by a painless genital papule, which usually disappears after a few days. The onset of the second stage occurs 2-6 weeks later and often manifests as unilateral inguinal lymphadenopathy. The third stage may occur years after the initial infection and is termed genitoanorectal syndrome.

Frequency

United States

Only 113 cases were reported to the Centers for Disease Control and Prevention in 1997. The true incidence of the disease is believed to be 400-600 cases per year.

International

LGV is most common in Southeast Asia, Africa, Central America, and the Caribbean. LGV accounts for 2-10% of genital ulcer disease in India and Africa.

Mortality/Morbidity

Complete cure is achieved by early recognition and appropriate antibiotic treatment.

Progression to the third stage of the disease can result in serious and sometimes permanent sequelae such as genital deformity, fistulas, and rectal strictures. Death is rare but may be caused by complete bowel obstruction and perforation resulting from a rectal stricture.

Race

As a cause of rectal strictures, LGV is found more commonly in blacks.

Sex

LGV is significantly more common in men than in women. Men are more likely to present with inguinal lymphadenopathy in the second stage of the disease. Women and homosexual men who engage in receptive anal intercourse are more likely to present with complications of late disease.

Age

Peak range is in individuals aged 15-40 years.

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