Lymphogranuloma inguinale

Alternative names

LGV; Lymphogranuloma venereum; Lymphopathia venereum

Definition

LGV is a sexually-transmitted disease (STD) caused by the bacteria Chlamydia trachomatis that causes inflammation and drainage of certain lymph nodes, and destruction and scarring of surrounding tissue.

Causes, incidence, and risk factors

Lymphogranuloma venereum (LGV) is caused by 3 subtypes of C. trachomatis. They are different organisms from the subtypes that cause eye disease, blindness, and the more common genital chlamydia.

LGV is more common in Central and South America than in North America. People with LGV can begin to have symptoms a few days to a month after becoming infected.

The disease starts as a painless ulcer on the male genitalia or in the female genital tract. As the organism spreads, the inguinal (groin) lymph nodes swell, become tender, and may rupture and drain through the skin. These enlarged nodes are called buboes.

The skin above the lymph node is often swollen (edematous) and red. These areas may appear to heal, but the patient will have repeated episodes of lymph node swelling and drainage. The patient may also have systemic signs including fever, decreased appetite, and malaise.

In people who practice anal intercourse, the disease can also affect the lymph nodes around the rectum (perirectal). This is often accompanied by bloody rectal discharge, painful defecation (tenesmus), diarrhea, and lower abdominal pain. Women may develop fistulas (connections) between the vagina and rectum.

There are a few thousand cases of LGV each year in the US. The main risk factor is having multiple sexual partners.

Symptoms

• Small painless ulcer on genitalia
  
• Swelling and redness of the skin over the inguinal lymph nodes
  
• Swollen groin (inguinal) lymph nodes on one or both sides
  
• Drainage from inguinal lymph nodes
  
• Drainage of blood or pus from the rectum (blood in the stools)
  
• Pain while having a bowel movement (tenesmus)
  

Signs and tests
The medical history and physical examination may show:

• A history of sexual contact with a person having lymphogranuloma venereum
  
• An ulcer on an affected person's genitals
  
• A perianal fistula with drainage