Lymphogranuloma Venereum is a rare sexual transmitted infection (STI). This STI is caused by any of the three different types of the bacteria Chlamydia trachomatis. But it is not caused by the same bacteria that can cause genital chlamydia.
The infection is typically transmitted during anal sex and will result in a long-term, meaning a chronic condition, of the lymphatic system. The infection may be accompanied by enlarged lymph nodes, rectum inflammation, ulcers, sores or abscesses in genital areas. Lymphogranuloma Venereum may be followed by complications if left untreated.
How is it transmitted?
Unlike genitourinary chlamydial infection which infects squamocolumnar epithelial cells, these serovars cause infection of mononuclear phagocytes in the lymphatic system.
Lymphogranuloma Venereum is transmitted through sexual contact. Meaning through vaginal, anal and oral sex.
Lymphogranuloma Venereum is more common in men than women. In fact, Lymphogranuloma Venereum endemic in tropical regions of the world, like certain areas of Africa, parts of Southeast Asia including India, as well as the Caribbean, and South America. Although rare in North America it is becoming common in the United States, but also in Western Europe (specially the Netherlands, and the UK), and Australia among men that have sex with men.
• Unprotected sexual intercourse
• Receptive anal intercourse
• Insertive oral intercourse
• Sexual contacts in endemic areas
• Multiple sexual partners
• Male gender
• Anal enema use.
Symptoms of Lymphogranuloma Venereum can begin a few days to a month after coming infected with the bacteria. But the main symptoms will be experience 2 – 6 weeks after the first lesion has developed. Men will develop lesions on their genitals and females in the genital tract. The sores are painless but are the first indication of the infection. The symptoms can include:
- Swollen lymph glands on one or both sides of the groin. It may also affect lymph nodes around the rectum in people who have anal intercourse
- There will also be drainage through the skin from the lymph nodes in the groin
- Females might experience swelling of the labia
- Pain during urination or when passing stools
- Swelling and redness of the skin in the groin area
- Constipation as well as painful bowel movements
- Rectal bleeding or pus from the rectum
- In men it is usually the coronal sulcus, frenulum, penile shaft, foreskin, glans, scrotum, urethra or anus that are affected
- Pain in lower abdomen or back, particularly it the infection was due to anal sex
- Pus-filled or bloody diarrhea
- Fever, chills, joint pain, decreased appetite and tiredness
- Low-grade fever, chills, malaise, myalgias, and arthralgias as the infection spreads.
Testing for Lymphogranuloma Venereum
The doctor will examine you and ask about your medical and sexual history. Tell your provider if you had sexual contact with someone you think has had symptoms of this infection.
A physical exam may show:
- An oozing, abnormal connection in the rectal area
- A sore on the genitals
- Drainage through the skin from lymph nodes in the groin
- Swelling of the vulva or labia in women
- Swollen lymph nodes in the groin.
Laboratory tests may include:
- Biopsy of the lymph node
- Blood test for the bacteria that causes the infection.
But if the tests indicate a positive reaction for the bacteria that is the cause of the infection, then you doctor will order other tests for chancroid, syphilis, and herpes. This is since if you are infected with this infection then the chances are higher that you will have another STD as well.
The infection is treated with antibiotics including doxycycline and erythromycin to cure the infection and prevent ongoing tissue damage. Treatment with erythromycin or doxycycline for at least 3 weeks is required. Azithromycin has also been used. If necessary, large swollen lymph glands may be drained.
With treatment, the outlook is good. That is since a proper treatment regimen cures the infection and prevents further damage to tissues. Therefore, an early and accurate diagnosis is essential.
Health problems that may result from Lymphogranuloma Venereum infection include:
- Abnormal connections between the rectum and vagina
- Brain inflammation, although very rare
- Infections in the joints, eyes, heart, or liver
- Long-term inflammation and swelling of the genitals
- Scarring and narrowing of the rectum
- Aseptic meningitis.
Complications can occur many years after you are first infected.
Condom use may reduce the risk of Lymphogranuloma Venereum transmission, but uncovered ulcerated areas remain a problem. With early and accurate diagnosis and appropriate antibiotic therapy, the prognosis is excellent, but reinfection and relapses may occur.