3. HISTORY
The history of LGV posed many controversies in the
scientific world. The accurate history was inconclusive
because how it started was never clearly stated in any
historical study.
In the 1950s, LGV was thought to have been caused by a
lymphotrophic virus which has a significant intracellular
replication ability and a relatively infrequency of co-
infection with multiple strains of chlamydia.
4. It was observed that the MSM (men who have sex
with men) presented with cases of LGV-related
formation of fibrotic tissue (proctitis) which required
surgical repair outnumbered the straight men with the
same condition.
5. BACTERIOLOGY
Lymphogranuloma venerum results from some bacteria
types known as Chlamydia. It’s also known as
“climatic bubo”, “Nicholas feuvre disease”, “chronic
elephantiasis” or “lymphogranuloma inguinale”
6. A chronic infection of the lymphatic system. The L1, L2 or
L3 serovars of Chlamydia trachomatis cause infection of
mononuclear phagocytes in the lymphatic system by
travelling from the site of inoculation down the lymphatic
vessels.
LGV is an emerging and significant public health concern in
western Europe and recently in Canada.
7. TRANSMISSION AND RISK FACTORS
The main risk factor is
being HIV positive
Unprotected sexual
intercourse
Receptive anal
intercourse
Sexual contacts in
endemic areas
Prostitution
Multiple sexual
partners
Male gender (MSM)
Anal enema use
8. TEST/ DIAGNOSIS
Detecting antibodies to chlamydial endotoxin
Presence of genital ulcers, swollen inguinal lymph nodes or
proctitis
Biopsy of lymph nodes
If LGV is misdiagnosed or partially treated, the natural history
of chronic long-lasting inflammation of the rectum may include
the development of fissures, perianal abscess and rectal strictures.
9. SIGNS AND SYMPTOMS
LGV progression has been divided into 3 stages- the
primary, secondary and tertiary stages.
The primary stage (rarely seen in women) sets in 3 days to 3 weeks
after exposure and mostly involves the site of inoculation…
Painless papule or shallow ulcer;
Groups of lesions resembling herpes infection;
At times, symptoms of urethritis;
A tender nodule in the regional lymph glands.
10. The secondary stage…
In cases of oral infections,
submaxilliary and cervical
lymph glands are affected
An oozing, abnormal
connection in the rectal area;
A sore on the genitals;
Drainage through the skin
from lymph nodes in the groin;
Swelling of the vulva or
labia in women;
Swollen lymph nodes in the
groin (inguinal
lymphadeonopathy)
The inflammation process
results in chronic odema
and sclerosing fibrosis
11. TERTIARY STAGE
The tertiary stage sets in with the absence of
treatment
Chronic inflammatory response
Genital ulcers
Chronic proctitis leading to rectal strictures
12. PREVENTION
Firstly , the awareness of the disease in different
nations of the world where they are endemic is essential.
The only sure way to prevent sexually transmitted
diseases is by not having sexual relations.
Safe sex behaviors reduce the risk. The proper use of
both male and female condoms greatly reduces the risk of
STIs.
13. TREATMENT
Oral tetracycline or erythromycin are known to be effective.
Doxycycline, erythromycin, and tetracycline are effective for
early disease.
Buboes can be drained by needle or surgically if necessary for
symptomatic relief .
Azithromycin is probably effective but neither it nor
Clarithromycin has been adequately evaluated.
Note: Buboes and sinus tracts may require surgery, but rectal
strictures can usually be dilated.
15. PROGNOSIS
With early diagnosis, full cure is expected with
appropriate antibiotic therapy.
A primary lesion can simply go unnoticed in the
urethra.
Swelling of damaged tissues in later stages may
not resolve despite elimination of the bacteria, and
complications can occur many years after one is first
infected.
16. RE-EMERGENCE
LGV re-emergence has been characterized by various atypical
clinical manifestations and this calls for a level of specialized
diagnostics and a new surveillance system to monitor its
occurrence.
According to the study conducted by Mintly Minna department of
infectious disease epidemiology, Imperial College London, LGV
breakout among MSM has reportedly increased since the early 2000
mostly in high-income countries.
17. CONCLUSION
Although this disease is rare, LGV should not be forgotten in the
differential diagnosis of rectal problems including rectal strictures. In view of
the increasing incidence of LGV in the West, it is important for physicians to
be acutely aware of LGV proctitis in high-risk patients.
Again, even though not it’s not as deadly as HIV or HPV, it can
leave one in a really bad state. Abstinence is the best prevention to any
sexually transmitted disease but if one must have sex, then one should make
sure to have protected sex .
