Operational Obstetrics & Gynecology

Lymphogranuloma Venereum (LGV)

Lymphogranuloma venereum is an uncommon sexually-transmitted disease caused by a variant of Chlamydia trachomatis.

Following initial exposure, there is mild, blister-like formation which is frequently unnoticed. Within the following month, there is ulceration of the vaginal, rectal or inguinal areas. At this stage, the disease is very painful, particularly with walking, sitting and with bowel movements. The stool may be blood-streaked.

Hard tender masses (buboes) arise in the inguinal area at this stage and are characteristic of the disease.

As the disease progresses untreated, extensive scarring in the rectal area may require surgery to enable normal bowel movements. Scarring in the vaginal area can lead to painful intercourse or make intercourse basically impossible.

Confirmation of the disease is optimally achieved with a positive Chlamydia trachomatis serotype culture from a bubo. Often, less specific tests, such as serum complement fixation test with acute and convalescent samples are used. In many operational settings, none of these tests are available and the diagnosis is made by history of exposure, visual appearance of the lesions and known prevalence in the population.

Optimal treatment is:

• Doxycycline 100 mg orally twice a day for 21 days, or
• Erythromycin base 500 mg orally four times a day for 21 days.

Because Azithromycin is effective against other presentations of Chlamydia trachomatis, it is likely, but unproven that use of multiple doses over several weeks would be effective against LGV.

CDC Treatment Guidelines