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Dermatologic Manifestations of Lymphogranuloma Venereum

  • Author: Jose A Plaza, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Oct 20, 2015
 

Background

Lymphogranuloma venereum (LGV) is a primarily cutaneous, and sometimes systemic, sexually transmitted disease (STD), which primarily affects lymphatic tissue of the groin. LGV is caused by unique serotypes L1, L2, and L3 of Chlamydia trachomatis. LGV occurs only sporadically in North America, but it is endemic in many parts of the developing world. A recent outbreak of LGV proctocolitis has been reported among homosexual men in North America and Europe, and many of these individuals were co-infected with HIV.[1, 2, 3, 4, 5, 6, 7]

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Pathophysiology

Lymphogranuloma venereum (LGV) is caused by C trachomatis, an obligate intracellular pathogen (ie, the bacterium lives within human cells), and strains L1, L2, and L3 have been associated with infection. LGV is primarily a disease of lymphatic tissue. Because Chlamydia species cannot traverse the intact epithelial barrier, access to lymphatic vessels is gained through microtrauma in the skin or mucous membranes. The pathogen then enters the draining lymph nodes, causing lymphangitis or lymphadenitis. The causal pathologic process involves thrombolymphangitis and perilymphangitis and the consequent spread of the inflammatory reaction from the affected lymph nodes to surrounding tissues.

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Epidemiology

Frequency

United States

Lymphogranuloma venereum (LGV) is rare in the United States, and the true incidence is not known.

International

Lymphogranuloma venereum (LGV) is most common in Southeast Asia, Africa, Central America, and the Caribbean. LGV accounts for 2-10% of genital ulcer disease in India and Africa.[8]

Race

Lymphogranuloma venereum (LGV) is found more commonly in blacks.

Sex

Lymphogranuloma venereum (LGV) is significantly more common in men than in women.

Age

The peak range for lymphogranuloma venereum (LGV) is in individuals aged 15-40 years.

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Contributor Information and Disclosures
Author

Jose A Plaza, MD Director of Dermatopathology, Department of Pathology, Froedtert Hospital; Assistant Professor, Department of Pathology, Section of Dermatopathology, Medical College of Wisconsin

Jose A Plaza, MD is a member of the following medical societies: American Medical Association, American Society for Clinical Pathology

Disclosure: Nothing to disclose.

Coauthor(s)

Victor G Prieto, MD, PhD Director of Dermatopathology, Professor, Departments of Pathology and Dermatology, University of Texas MD Anderson Cancer Center

Victor G Prieto, MD, PhD is a member of the following medical societies: American Society of Dermatopathology, College of American Pathologists, American Association for the Advancement of Science, International Society of Dermatopathology, European Society of Pathology, American Medical Association, American Society for Clinical Pathology, Society for Investigative Dermatology, United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Lester F Libow, MD Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Jennifer D. Lorek, MD, Scott M. Acker, MD, Peter Langenstroer, MD, and Milton W. Datta, MD, to the development and writing of this article.

References
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  2. Herida M, de Barbeyrac B, Sednaoui P, et al. Rectal lymphogranuloma venereum surveillance in France 2004-2005. Euro Surveill. 2006 Sep. 11(9):155-6. [Medline].

  3. Kapoor S. Re-emergence of lymphogranuloma venereum. J Eur Acad Dermatol Venereol. 2008 Apr. 22(4):409-16. [Medline].

  4. Klint M, Lofdahl M, Ek C, Airell A, Berglund T, Herrmann B. Lymphogranuloma venereum prevalence in Sweden among men who have sex with men and characterization of Chlamydia trachomatis ompA genotypes. J Clin Microbiol. 2006 Nov. 44(11):4066-71. [Medline].

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  8. Thappa DM, Sivaranjini R. Venereology in India. Indian J Dermatol. 2011 Jul. 56(4):363-7. [Medline]. [Full Text].

  9. Chen CY, Chi KH, Alexander S, et al. The molecular diagnosis of lymphogranuloma venereum: evaluation of a real-time multiplex polymerase chain reaction test using rectal and urethral specimens. Sex Transm Dis. 2007 Jul. 34(7):451-5. [Medline].

  10. Hadfield TL, Lamy Y, Wear DJ. Demonstration of Chlamydia trachomatis in inguinal lymphadenitis of lymphogranuloma venereum: a light microscopy, electron microscopy and polymerase chain reaction study. Mod Pathol. 1995 Dec. 8(9):924-9. [Medline].

  11. Klotz SA, Drutz DJ, Tam MR, Reed KH. Hemorrhagic proctitis due to lymphogranuloma venereum serogroup L2. Diagnosis by fluorescent monoclonal antibody. N Engl J Med. 1983 Jun 30. 308(26):1563-5. [Medline].

  12. [Guideline] Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015 Jun 5. 64 (RR-03):1-137. [Medline].

  13. Gilleece Y, Sullivan A. Management of sexually transmitted infections in HIV positive individuals. Curr Opin Infect Dis. 2005 Feb. 18(1):43-7. [Medline].

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