Dermatologic Manifestations of Lymphogranuloma Venereum

Updated: Oct 19, 2015
  • Author: Jose A Plaza, MD; Chief Editor: Dirk M Elston, MD  more...
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Overview

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. An 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]

See the image below.

Lymphogranuloma venereum is caused by the invasive Lymphogranuloma venereum is caused by the invasive serovars L1, L2, or L3 of Chlamydia trachomatis. This young adult experienced the acute onset of tender, enlarged lymph nodes in both groins. Courtesy of Wikimedia Commons (Herbert L. Fred, MD, and Hendrik A. van Dijk, http://cnx.org/content/m14883/latest/).
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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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Prognosis

Prognosis is excellent if lymphogranuloma venereum (LGV) is treated early; however, late complications can cause significant morbidity. Progression to the third phase of LGV can result in serious and permanent sequelae such as genital deformity, fistulas, and rectal strictures, among others. Complete cure is achieved by early recognition of LGV and appropriate antibiotic treatment.

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Patient Education

Instruct patients that infection confers little or no protective immunity. Refer sexual contacts for evaluation and possible treatment. Encourage safe sex.

For patient education resources, visit the Sexual Health Center. Also, see the patient education articles Sexually Transmitted Diseases and Chlamydia.

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