Lymphogranuloma Venereum (LGV)

What is lymphogranuloma venereum?

Lymphogranuloma venereum (LGV) is a sexually transmitted disease (STD). The first stage of LGV causes genital blisters. The second stage of LGV leads to swollen, painful lymph nodes in your groin, pelvis or rectum.

Antibiotics can usually treat LGV, but untreated LGV can cause long-term damage to your lymphatic system. LGV can also increase your risk of getting HIV and other STDs.

Who might get lymphogranuloma venereum?

Sexually active people between ages 15 and 40 years old are at highest risk of lymphogranuloma venereum. Both men and women may get LGV. But men who have sex with men have more reported cases than women. People with HIV are also at higher risk.

How common is lymphogranuloma venereum?

Tropical and subtropical regions have the highest incidence of lymphogranuloma venereum. Cases of LGV in the United States are rare. But men who have sex with men have had outbreaks of LGV in North America, Europe and Australia. For instance, 22 European countries reported 2,389 total cases of LGV in 2018.

What causes lymphogranuloma venereum?

A bacteria called Chlamydia trachomatis causes lymphogranuloma venereum. Types of this bacteria called serovars L1, L2 and L3 cause LGV. A different type of chlamydia bacteria (serovars D-K) causes the more common sexually transmitted disease chlamydia. LGV can be transmitted through anal, vaginal or oral sex.

What are the symptoms of lymphogranuloma venereum?

Symptoms of LGV start usually about three to 12 days after an infection happens. Sometimes symptoms may not appear for up to 30 days. Symptoms happen in three stages:

First stage: You develop small blisters (usually 1 to 6 millimeters in size) filled with fluid on your penis or in your vagina. These blisters usually don’t cause pain and heal quickly. You may also have sores in your mouth or throat.

Second stage: This stage happens about two to six weeks after the first stage. Symptoms may include:

• Swollen, tender lymph nodes in your groin (buboes), especially in men.
• Swollen, painful lymph nodes in your pelvis and near your rectum, especially in women.

The skin over your lymph nodes may break down. This results in a passageway (sinus tract) that lets blood or pus drain out onto your skin.

Other symptoms may include:

• Abdominal pain.
• Anal pain.
• Back pain or pelvic pain in women.
• Body aches.
• Constipation.
• Fatigue.
• Feeling like you need to pass stools (poop).
• Headache and fever.
• Inflammation of the rectum and anus (proctitis).
• Rectal bleeding, itching or discharge.
• Painful urination (dysuria) and pain while passing stools (pooping).
• Unexplained weight loss.

Third stage: This stage usually occurs when LGV hasn’t been properly treated. In the third stage, the sores heal but often leave scars. You may also still have sinus tracts.

Other symptoms may include:

• Abscesses.
• Anal fistulas.
• Deformed genitals.
• Narrowing of the rectum (rectal strictures).
• Pelvic floor dysfunction.
• Swelling of your genitals.

How is lymphogranuloma venereum diagnosed?

Your healthcare provider will first ask about your symptoms and sexual history. They will then do a physical examination. If they suspect LGV, they may suggest tests including:

• Blood test, which looks for antibodies against chlamydia trachomatis.
• Nucleic acid amplification test (NAAT), which looks for chlamydia trachomatis in a sample taken from your groin, rectum or lymph node.

Providers tend to diagnose men in the earlier stages and women in the later stages of the condition.

How is lymphogranuloma venereum treated?

Providers treat LGV with the antibiotic doxycycline. They usually recommend 100 milligrams of doxycycline twice a day for 21 days. Providers may prescribe erythromycin or azithromycin as alternative treatments.

Providers may also recommend a needle biopsy (fine needle aspiration, or FNA) of any pus-filled lymph nodes in your groin (buboes). FNA can help with relief from pain and discomfort.

How can I reduce my risk of lymphogranuloma venereum?

You can reduce your risk of LGV by:

• Avoid unsafe sex, including having multiple sex partners at the same time.
• Get diagnosed and treated for sexually transmitted diseases (STDs) when symptoms first occur.
• Let your sexual partners know if your provider diagnoses you with LGV. You should inform any partners you had within 60 days before your diagnosis. They can then get tested and treated if necessary.
• Use condoms or other protection when having sex.

What can I expect if I have lymphogranuloma venereum?

You may experience certain complications if you have long-term untreated LGV:

• Anal fistulas.
• Blockage of the lymph fluid that passes through your lymphatic system (lymphatic obstruction).
• Enlargement of your genitals.
• Infertility.
• Joint disease caused by infection (reactive arthropathy).
• Narrowing of the rectum (rectal strictures).
• Substantial swelling of your genitals (elephantiasis).

You may also be at higher risk of developing hepatitis and pneumonia. If fistulas or strictures cause serious damage to your anus or rectum, you may need surgery.

What is the outlook if I have lymphogranuloma venereum?

If your provider treats you for LGV at an early stage, you can have a full recovery. Studies show that taking doxycycline for 21 days cures more than 98.5% of LGV cases. You may still have swelling if LGV has damaged the tubes (lymphatic vessels) that carry fluid (lymph) away from your tissues.

People with LGV are at higher risk for other STDs, including:

• Gonorrhea.
• HIV.
• Hepatitis B.
• Hepatitis C.
• Syphilis.

Your provider may recommend testing for these and other STDs. This way you can get treatment if needed. You should also get retested for chlamydia trachomatis about three months after your treatment.

How do I take care of myself with lymphogranuloma venereum?

You should refrain from sexual activity until after you complete treatment for LGV. After that, practice safe sex to avoid future reinfections.

A note from Cleveland Clinic

Lymphogranuloma venereum (LGV) is a sexually transmitted disease (STD). LGV can be transmitted by anal, vaginal or oral sex. LGV symptoms occur in three stages. Symptoms include blisters filled with fluid followed by swollen lymph nodes in your groin, pelvis or rectum. Complications may include infertility and enlarged genitals if you don’t treat LGV quickly. Providers can successfully treat lymphogranuloma venereum with antibiotics. If your provider treats you early, you can make a complete recovery.