Lymphogranuloma venereum (LGV) is caused by certain types of the bacterium Chlamydia trachomatis. LGV is endemic in some tropical regions of the world. LGV has been rare outside these regions for several decades; however outbreaks of LGV among gay men started to be reported in late 2003 in the Netherlands and Germany and then in the rest of Western Europe. There have also been several outbreaks of LGV in Australia in recent years.
LGV can be passed on through unprotected anal, vaginal or oral sex. Condoms reduce the likelihood of transmission. The use of latex gloves for fisting (and not using the same gloves with different partners) can also prevent transmission of LGV.
The clinical course of LGV is divided into three stages:
The initial symptom is usually a painless papule or shallow ulcer on the penis, urethra, vulva, vaginal wall or cervix, or in the rectum. This appears after an incubation period of 3-30 days. This lesion does not always appear or may pass unnoticed. In fact only 25-35 per cent of people report having had any lesions.
A few weeks after the primary lesion there can be painful and swollen lymph glands in the groin. The secondary stage may also include proctitis - pain and inflammation in the anus and rectum (with more severe inflammation than non-LGV infections), rectal bleeding, anal discharge, constipation, cramping.
In the tertiary stage, lymphatic obstruction may cause extreme swelling (elephantitis) of the genitals of both men and women.
Diagnosis of LGV is by clinical findings in combination with a swab.
Treatment is a course of antibiotics for 21 days.
Using condoms for anal sex can reduce the risk of passing on LGV. Wearing gloves for arse play or using a dam for rimming can also reduce the chance of transmission. You should wash your hands after handling used condoms or sex toys or after having sex involving arse play.
If you are HIV-positive, Proctitis can increase your viral load. This means that it is easier to pass HIV on to other people while you have Proctitis.
In people with HIV the lesions associated with LGV may be deeper, larger and more numerous.
Treatment for LGV does not differ according to HIV status. However the time to heal may be more prolonged in people with HIV.