Public health priority: Routine.
PHU response time: Enter on NCIMS within 5 working days of notification.
Case management: Responsibility of treating doctor.
Contact management: Responsibility of treating doctor. PHUs should assist if requested.
To monitor the epidemiology of the disease and so inform prevention strategies.
A confirmed case requires:
Isolation of Lymphogranuloma venereum (Chlamydia trachomatis serovars L1, L2 or L3)
Detection of Lymphogranuloma venereum (Chlamydia trachomatis serovars L1, L2 or L3) by nucleic acid testing
Lymphogranuloma venereum is to be notified by:
Only confirmed cases should be entered onto NCIMS.
The bacterium Chlamydia trachomatis (serovars L1-3).
LGV is usually transmitted during sexual intercourse with an infected person. Rarely, the infection can also be transmitted from mother to baby during birth.
The typical incubation period is variable, with a range of 3 to 30 days for a primary lesion. If a bubo is the first manifestation, the range is from 10 to 30 days up to several months. 1
The period of communicability is variable and has not been well defined.2
The usual clinical presentation begins with a small painless lesion on the genital area or on an extra-genital site of inoculation3, followed some weeks later by lymphadenopathy. Affected lymph nodes, which in males are usually inguinal and in females pelvic, may progress to fluctuant buboes. Proctitis may result from anal intercourse and is not usually accompanied by symptomatic lymphadenopathy. Inflammatory responses may result in systemic symptoms, including fever, chills, malaise and joint and muscle pains. Asymptomatic infections can also occur.2
Within 5 working days of notification enter confirmed cases on NCIMS.
The response to a notification will normally be carried out in collaboration with the case's health carers. But regardless of who does the follow-up, PHU staff should ensure that action has been taken to:
In general, the attending medical practitioner is responsible for treatment. Specialist advice is usually required. Refer to Therapeutic Guidelines: Antibiotic.
In general, the case's doctor provides education and counselling. The medical practitioner should provide information to the case about the nature of the infection and the mode of transmission.
Sexual contacts in the 3 months before the first symptoms appeared, or since arrival from an endemic area. For asymptomatic cases, contact tracing should be undertaken for partners in the 6 months prior to diagnosis.
The treating doctor is responsible for contact tracing. PHUs should work with Sexual Health Service staff to assist if requested. Contacts require counselling, examination, testing and presumptive treatment.
Given that LGV is a rare disease in NSW, reports of several cases in an area may prompt public health action including an alert to GPs with relevant advice regarding clinical management and contact tracing. This should be done in collaboration with the Communicable Diseases Branch and local sexual health services.