Factsheet LGV (lymphogranuloma venereum)

Michael Carter, Published October 2013

Key points

  • LGV is a form of chlamydia and tests for chlamydia also detect LGV.
  • Most LGV cases are in HIV-positive gay men.
  • LGV is treated with a course of antibiotics.

Lymphogranuloma venereum (LGV) is a form of the common sexually transmitted infection chlamydia. It can have serious consequences if left untreated.

LGV is caused by specific strains of the Chlamydia trachomatis bacteria (strains L1, L2, L2b and L3) and is more invasive (i.e. gets into the tissue of the body) than more common types of Chlamydia.

LGV is common in parts of Africa, Asia, and South America but was rare in Western Europe before 2003. In 2004 a cluster of LGV infections was seen amongst gay men who had attended sex parties in the Netherlands. The infection was quickly spread across Western Europe and cases have also been reported in the United States and Australasia. 

Since then, the number of cases of LGV in the UK rose steadily, peaking in 2010, and it is now considered a sustained outbreak. The majority of LGV outbreaks in the UK have occurred in London, Brighton and Manchester, although many areas of the UK have now reported smaller numbers of cases.

"The risk of LGV infection can be reduced by using condoms consistently and correctly during sex and using latex gloves for fisting."

Nearly all these cases are in men who have sex with men (MSM), and HIV co-infection is common in people diagnosed with LGV.

Symptoms

Symptoms can be complex and severe, causing swollen lymph nodes, fever, muscular pain and general ill health.

There are three stages of infection and symptoms vary depending on which part of the body is infected. They can affect different parts of the body, such as the genitals, the anus, rectum, mouth and lymph nodes. 

Stage one: Symptoms usually develop between three days and three weeks after exposure. A small painless blister or sore appears where the infection first entered the body. This may go unnoticed. There can be small groups of these, which look a little like herpes infection. There may also be symptoms similar to a urinary tract infection. A tender spot can develop in the lymph glands in the groin.

Stage two: Usually between ten and 30 days after exposure, inflamed and swollen lymph glands may then appear in the groin, armpit or neck. Anal infection can cause painful ulcerations, discharge and bleeding. Fever and rash may develop.

Stage three: If left untreated, the symptoms can become more severe, causing general swelling of the lymph glands, extreme swelling of the genitals, with ulcers, and damage inside the rectum or vagina, causing lasting damage to infected tissue and general health. Scarring, swelling and deformity in infected areas has also been reported. Complications of the untreated infection may require surgery. Spread of the bacteria throughout the body can occasionally lead to arthritis or inflammation of the lungs. Symptoms can occur up to 20 years after infection.

Women usually have no symptoms after first being infected. In the cases in MSM seen in the UK over the last ten years, cases have presented with symptoms of proctitis (inflammation of the lining of the rectum). These include rectal pain, rectal discharge, bloody stools, constipation and tenesmus (the feeling of needing to empty the bowels). 

You can still pass the infection on to sexual partners if you don’t have symptoms.

Transmission

LGV is almost exclusively transmitted sexually. The bacteria enter a moist mucosal surface – most commonly the rectum or vagina, but infections in the penis or mouth are also possible. Like all sexually transmitted infections, anyone who has unprotected vaginal, anal and/or oral sex can catch LGV.

Most cases reported in the UK have been in gay men and particularly high rates of LGV have been seen in HIV-positive gay men. Infection with hepatitis C and with another sexually transmitted infection (such as gonorrhoea, syphilis, hepatitis C, and genital herpes) is also common for those with LGV. The two activities most commonly implicated in LGV transmission are unprotected anal intercourse and fisting. Sharing of sex toys can also lead to LGV transmission.

Prevention

The risk of LGV infection can be reduced by using condoms consistently and correctly during sex and using latex gloves for fisting. If you are having sex with more than one person, a new condom or glove should be used with each man. If condoms or gloves are not used, thorough washing between partners is better than nothing.

Using condoms with shared sex toys or cleaning them thoroughly with hot soapy water between uses also reduces the risk of passing on LGV.  

If you find out you have had sex with someone who has LGV, have a check-up immediately and don’t have sex again until you have been given the all-clear.

Diagnosis

Tests for Chlamydia will also detect LGV infection, so a negative Chlamydia test means no LGV infection. Chlamydia is usually diagnosed by checking a urine sample, particularly for men. Swabs may be taken to see if the infection is present in the urethra, vagina or cervix. If you have had anal or oral sex, you may have swabs taken of your throat or anus.

If you test positive for Chlamydia and have LGV-type symptoms, you will have a specialised test to clarify whether the infection is LGV rather than another type of Chlamydia. 

People who are sexually active are advised to have regular sexual health check-ups, where they will be tested for a range of sexually transmitted infections. Most HIV treatment centres have an associated sexual health clinic. These offer confidential and free treatment. You don't need to be referred by your GP or your HIV doctor.

If you are concerned that you might have LGV, then it's a good idea to make sure that you tell the doctors or nurses at the clinic you are attending.

Treatment

Most cases of LGV can be treated using a 21-day course of the oral antibiotic doxycycline. There are other antibiotics that will work against LGV if this is not suitable for some reason.

It is important that you do not have sex if you have LGV, or any other sexually transmitted infection, until follow-up tests confirm that you no longer have the infection. 

Sexual partners who may have been at risk of infection should also, if possible, be identified, tested and treated.

It is possible to become infected with LGV again after being successfully treated. To avoid this, make sure any of your sexual partners have also been treated. Condoms, used properly and consistently, can prevent infection with LGV and many other sexually transmitted infections.

This factsheet is due for review in October 2016

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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.