Lymphogranuloma venereum

• 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. LGV is rare in Australia, but there have been recent increases in MSM (external site).
• LGV among MSM is common in North Europe and North America and is endemic in the general population in several tropical areas such as South-East Asia, Southern Africa and India

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.

Special Considerations 

The site of primary lesion depends on the site of inoculation. Proctitis is characterised by rectal pain, bleeding, rectal discharge, tenesmus and changed bowl habit. LGV in Australia is usually symptomatic, hence routine screening of asymptomatic patients is not recommended (external site)

LGV can progress to serious complications, including chronic proctitis, fistulae, strictures and genital oedema. Therefore timely diagnosis and treatment are important. 

STI Atlas (external site)

• Demonstration by NAAT of C. trachomatis in fluid aspirated from a fluctuant bubo.
• Specific testing for rectal LGV for C. trachomatis NAAT positive samples is available on request from PathWest and RPH. All positive rectal chlamydia samples should be sent for confirmatory testing.
• Serology – the LGV complement fixation test (LGV-CFT) is the most widely available serological test. Titres > 1:64 are highly suggestive of LGV in a patient with a compatible clinical picture, but cannot be used to differentiate between recent and prior treated infection. 

Standard

• Doxycycline 100 mg orally, 12-hourly for 21 days or longer

Special consideration

Advise no sexual contact until treatment is finished 

• Azithromycin 1 g orally weekly for three weeks or erythromycin 500mg qid for 21 days should only be considered after discussion with a sexual health physician if patient is a concern. Data on alternative regimens is scanty. 

Pregnancy

• Erythromycin 500 mg orally, qid for 21 days or longer (category A).
• Medicines in pregnancy.

Doxycycline is contraindicated in pregnancy.

Related links

• Lymphogranuloma venereum (Healthy WA)

Current partners and partners over the previous six months should be assessed and offered STI screening and empirical LGV treatment.

• Consider other STIs.
• Test of cure should occur 3 weeks after treatment completion. 

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.

Epidemiology of STIs and BBVs in Western Australia

Lymphogranuloma venereum notification data