Lymphogranuloma venereum (LGV) is a STD infection which is caused by Chlamydia trachomatis, serovars L1, L2, and L3. This infection is most widespread in some parts of Africa, Southeast Asia, India, Caribbean and Latin America. Initially, LGV was rare in hi-income countries of the Americas, Europe and United Kingdom but has been reported more frequently in the past decade specifically causing outbreaks in proctitis among MSM. 

LGV is also a genital ulcer disease together with other STIs including HSV, syphilis and chancroid. This is usually characterized by genital papules or ulcers that may initially be asymptomatic, then painful enlargement of the inguinal or femoral lymph nodes as the first sign of infection. Further, it is evident that human beings who have contracted LGV may also develop rectal ulcers as well as proctocolitis if he/she is involved in receptive anal intercourse frequently. Such rectal symptoms as pain, discharge or bleeding could be confused with other conditions such as colitis. If left untreated, LGV can cause serious consequences such as genital ulceration, genital hypertrophy, and lymphatic obstruction. 

LGV is a disease that is common in the tropical and subtropical areas of the world but is not frequently reported in America. Although it can develop in anyone, it is most prevalent in sexually active individuals between the age of 15   to 40 years. Even though LGV appears to affect both sexes, it is commonly diagnosed in males since they present early symptoms. This infection is more prevalent in men who have sexual contacts with other men and has a close link with HIV. Males typically experience severe manifestations of the disease, whereas females will typically only show symptoms once the disease has progressed to the more advanced stage. 

Chlamydia trachomatis is one of the obligate intracellular bacteria and LGV is caused by L1, L2, L3 serotypes. These serotypes are more invasive and tend to cause systemic infections by tracking through the lymphatic system following direct contact with infected skin or mucous membranes. While the virus is mostly spread through sexual contact, there have been some instances of nonsexual transmission. The L2b serovar has been associated with a chronic though previously unidentified infection in HIV-positive individuals. 

LGV progresses in three stages: an asymptomatic, non-tender papule in the first stage; tender inguinal adenopathy in the second; and proctocolitis, especially in women and MSMs, in the later stages. 

The bacteria responsible for this infection are Chlamydia trachomatis of the L1, L2 and L3 serovars. Chlamydia is a rod-shaped bacterium that is intracellular by nature and occurs commonly in ovoid form. 

Recovery rates are high, however, if patients receive an appropriate antibiotic regimen at the right time, the prognosis is good. But it should always be made clear to the patient that he or she can get the illness again and that relapses can happen. 

Age Group 

• Early Stage: The primary stage presents a genital papule or ulcer that may not be palpable or painful; it has no symptoms and is self-healing. 
• Second Stage: About 2 to 6 weeks later painful inguinal or femoral lymphadenopathy develops, and this is when the patient seeks medical help. 
• Late Stage: This stage involves proctocolitis, especially in MSMs and women. Signs and symptoms may include perianal pain or discomfort, perianal discharge, recurrent bleeding per rectum, and sometimes, generalized sepsis. This stage can be more severe and may lead to chronic complications, especially when it is left untreated. 

Lymphadenopathy: In the second stage of LGV, the patients may present with unilateral or bilateral swelling of the inguinal and / or femoral lymph nodes. These nodes are typically soft, sometimes present with groove sign, and may become fluctuant forming buboes that may rupture leading to discharge of pus. 

Proctocolitis: In the later stages the disease manifestations include proctocolitis which may affect MSM and women. Abdominal palpation may indicate signs of peritoneal irritation, while proctoscopy may reveal tenderness, discharge and inflammation or ulcers of the rectal mucosa, which can be suggestive of other bowel conditions. 

Genital Elephantiasis: In chronic or untreated cases of LGV, lymphatic obstruction may become severe and lead to enlargement and distortion of the external genital organs. 

HIV infection 

Sexually transmitted infections 

Early Stage: The primary stage presents with a genital papule or ulcer that may not be palpable or painful; it has no symptoms and is self-healing. 

Second Stage: About 2 to 6 weeks later painful inguinal or femoral lymphadenopathy develops, and this is when the patient seeks medical help. 

Late Stage: This stage involves proctocolitis, especially in MSMs and women. Signs and symptoms may include perianal pain or discomfort, perianal discharge, recurrent bleeding per rectum, and sometimes, generalized sepsis. This stage can be more severe and may lead to chronic complication especially when it is left untreated. 

Antibiotic Therapy: 

• First-Line Treatment: Adults: Doxycycline 100 mg twice a day for 21 days. This is the most recommended treatment for LGV because of its efficacy in treating the causative serovars. 
• Alternative Treatment: Alternatives to doxycycline include Azithromycin 1 g orally once a week for 3 weeks or Erythromycin 500 mg orally four times daily for 21 days. 

Management of Symptoms and Complications: 

• Pain and Swelling: Anti-inflammatory drugs may be administered on the affected area to control pain and inflammation. 
• Abscesses or Buboes: Lukewarm compress can be helpful in reducing the extent of pain. When buboes become fluctuant or are likely to rupture, surgical aspiration may be required. 

Proctocolitis Management: 

• Treatment of Proctocolitis: If present, supportive care includes pain and rectal symptoms management. Antibiotic treatment should target the infection which caused the abscess 

Infectious Disease

Warm Compresses: Intake of warm wet packs over affected enlarged palpable nodes (buboes) can help in relieving pain and inflammation and in the softening and subsequent opening of fluctuant abscesses. 

Pain Management: Self-care treatment involves the use of analgesic drugs which include acetaminophen, ibuprofen which can minimizes the pain and inflammation of the LGV lesions and lymphadenopathy. 

Wound Care: In patients with ruptured buboes or genital ulcers, simple wound dressing is critical to minimize formation of scar and occurrence of secondary infection. In general, cleanliness is important; the area has to be dry, and dressings have to be sterile, if used. 

Hygiene Measures: It is very important to wash oneself well regularly, avoid using other people’s utensils and clothing, and avoid contact with infected persons to minimize the chances of secondary infections that delay recovery. Cleaning should be done with mild soap and clean water, preferably daily. 

Infectious Disease

Doxycycline: It achieves this through interfering with bacterial protein synthesis. It achieves this by interacting with the 30S ribosomal subunit of the bacteria and potentially the 50S subunit and inhibiting bacterial growth. 

Erythromycin: It is effective in limiting bacterial growth by preventing the release of peptidyl t-RNA, thus preventing the synthesis of protein through RNA- dependent pathways. It is prescribed for the treatment of bacterial infections produced by staphylococci and streptococci. In children, dosage depends on age, weight, and nature of infection: mild, moderate or severe. When administering the drug for twice daily dosing, the total daily dosage is divided into two doses taken in a 12-hour interval. 

Infectious Disease

Azithromycin: A highly recommended regimen is 1g oral azithromycin once a week for three consecutive weeks. 

Infectious Disease

Drainage of Abscesses: If LGV results in painful or large abscesses, the abscesses may need to be incised and drained to relieve the symptoms and prevent additional problems. 

Debridement: Debridement of the wound may be required if the tissue damage is extensive or if there is an issue with tissue necrosis. 

Fistula Repair: LGV in some instances causes the buildup of fistulas which are passageways in between two tissues or even body organs. These fistulas may require surgical intervention to reduce their size and allow the normal anatomic structures to be reconstructed.

Pelvic Surgery: It may follow that if any of these criteria are met or if there is extensive pelvic involvement or complications such as rectal strictures, then more extensive pelvic surgery may be needed. 

Infectious Disease

LGV’s management generally consists of the different stages in treating the infection and its syndromes. Initially, the diagnosis involves clinical assessment and historical analysis to identify the presence of Chlamydia trachomatis and further biochemical assays. This is then succeeded by the initial treatment stage which involves using antibiotics, mostly doxycycline or erythromycin depending on the situation to help cure the infection, alongside managing its symptoms. 

In the process of treatment, the follow-up stage is crucial for the assessment of the results of using antibiotics and the absence of a disease. If complications occur, for instance abscess or fistulas, the complication management stage entails surgical procedures to treat such complications as well as resulting disability.