Lymphogranuloma Venereum

Sexually transmitted infection caused by Chlamydia trachomatis

Aetiology

Causative organism:
  • Chlamydia trachomatis serovars L1, L2, L3
Microbiological characteristics:
  • Obligate intracellular bacterium
  • Gram-negative–like cell wall (lacks peptidoglycan)
  • Exists in two forms:
    • Elementary body (infectious)
    • Reticulate body (replicative)

Clinical presentation

  • The clinical presentation is divided into primary, secondary and tertiary patterns

Primary Stage

Incubation period:
  • 3–30 days
Primary lesion:
  • Small papule, vesicle, or shallow ulcer
  • Painless
  • Heals rapidly
  • Often unnoticed

Secondary Stage (Inguinal Syndrome)

Occurs 2–6 weeks after primary lesion.
Key Features:
  • Painful inguinal and/or femoral lymphadenopathy
  • Usually unilateral
  • Nodes become matted and suppurate
Groove Sign (Pathognomonic):
  • Inguinal and femoral lymph nodes separated by the inguinal ligament
  • Produces a visible groove
Systemic symptoms:
  • Fever
  • Malaise
  • Myalgia

Tertiary Stage (Anogenital Syndrome)

Occurs months to years later if untreated.
Features:
  • Chronic inflammation
  • Fibrosis
  • Lymphatic obstruction
Complications:
  • Genital elephantiasis (esthiomene)
  • Anal strictures
  • Rectovaginal fistulae
  • Chronic edema and scarring

Investigations

  • Giemsa Stain → Gamma-Favre Bodies
  • NAATs (Gold Standard)
  • LGV-specific genotyping (where available)
  • Serology (supportive but not definitive)

Management

  • Doxycylin 100mg BID PO for 14 days
  • Erythromycin 500mg QID PO for 7 days
  • Tetracyclin 500mg QID PO for 7 days