Lymphogranuloma venereum (LGV)

Last updated: 30 January 2008

What is lymphogranuloma venereum (LGV)?

Lymphogranuloma venereum, or LGV, is a sexually transmitted infection. The bacteria that cause LGV are rare types of chlamydia, however LGV infection is a more aggressive disease than common chlamydia infection. In the past people with LGV have contracted the disease overseas, especially in Southeast Asia, Africa, Central and South America and the Caribbean. More recently, the infection has spread to Europe and North America, where it has mainly affected men who have sex with men.

What are the symptoms?

• Around three to 30 days after exposure, a small painless lump or sore appears on or in the penis, rectum, vagina, cervix or mouth. The initial lesion heals after a few days and most people are not aware of it.
• Over the next two to six weeks, the infection spreads to the local lymph glands usually in the groin or inside the pelvis. People may also have fever, chills, weight loss, feel generally unwell or have sore muscles and joints. Where the infection is around the rectum, there can be a discharge of blood, pus or mucus from the anus, a painful urgent feeling of needing to pass a bowel motion but being unable to do so, diarrhoea or constipation, and lower abdominal pain.
• In the final stages, the infection can cause widespread scarring and deformity in the affected area.
• Rarely, LGV can infect the brain and its lining and can also infect the liver.

How is it spread?

LGV is spread through unprotected vaginal, anal or oral sexual contact, especially if there is trauma to the skin or mucous membranes. It can also be spread via sharing of sex toys between partners.

Who is at risk?

• People who travel to countries with LGV and who have unprotected sex with someone with the infection.
• Men who have sex with men, especially those that have unprotected anal sex. Recently, LGV has emerged in Europe and North America in men who have sex with men and especially amongst men who have anonymous sex with multiple partners, practice "fisting", practice rough sex, or share sex toys. Many of these men also have HIV, other sexually transmitted infections and hepatitis C.

How is it prevented?

• Use condoms or other barrier methods for oral, vaginal and anal sex. A water-based lubricant should also be used.
• Avoid sex with people who have a new genital lump or sore.
• Avoid skin contact with any abnormal discharge from the groin or anus.
• Sex partners should not share sex toys, or toys should be washed and protected with a condom between partners.
• Regular sexual health checks are important and people at risk should see their GP or sexual health clinic if they have symptoms.

How is it diagnosed?

• The diagnosis can be difficult to make because the disease is rare in Australia and mimics many other more common conditions. Blood tests can help to make a diagnosis but samples of fluid from the swollen lymph glands or swabs from rectal lesions are important to confirm the diagnosis.
• LGV often coexists with other sexually transmitted infections (including HIV) and hepatitis C, so it is important to also conduct tests for these.

How is it treated?

Antibiotics are effective in treating the LGV infection. People with LGV should not have sex until the full course of antibiotic treatment has been completed. Painful swollen lymph nodes may need to be drained using a needle. Sometimes surgery is required in later stages of the disease.

Other infections that often co-exist with LGV (such as HIV, other STIs and hepatitis C) should also be treated if they are diagnosed.

What is the public health response?

Laboratories must notify cases of LGV to the public health unit. Patients and their doctors should ensure that sexual partners who may have been exposed to the LGV lesion or fluid from a discharging lymph gland or from the rectum are contacted for assessment, counselling and antibiotic treatment.