Lymphogranuloma venereum (LGV) is caused by Chlamydia trachomatis (C. trachomatis) serotypes L1 – L3, which differ from those that cause urethritis or cervicitis. LGV has recently been acquired locally so can no longer be seen as only an imported disease.
The initial lesion is a transient ulcer that usually appears 3 to 10 days after infection. This may go unnoticed, and most patients present some weeks later with inguinal lymphadenopathy, which may progress to form a fluctuant bubo by the time the patient is seen. It may also present as painful proctitis and should be suspected in MSM with ano-rectal symptoms.
Azithromycin 1 g orally weekly for three weeks (for MSM and HIV antibody positive patients). Data on the efficacy of weekly azithromycin is scanty.
Doxycycline is contraindicated in pregnancy.
Current partners and partners over the previous six months should be assessed and offered STI screening and empirical LGV treatment.
This is a notifiable disease.
Contact tracing is important to prevent further infection and treat contacts.
Always test for other STIs.
This is a notifiable infection. Medical practitioners must complete the appropriate notification forms for all patients diagnosed with a notifiable STI/HIV, as soon as possible after confirmed diagnosis.