Overview
Lymphogranuloma venereum describes inflammation of the inguinal nodes due to certain serotypes of Chlamydia trachomatis, particularly serotypes L1, L2, and L3. It is a sexually transmitted infection (STI). It is transmitted through penetrative sexual intercourse and skin abrasions, however, it can also spread by splashes of genital fluids.
Pathophysiology
Upon entering the body, Chlamydia trachomatis enters cells and forms inclusion bodies, which mature and cause the cell to rupture, resulting in free bacteria entering other cells and repeating the cycle. Due to this lifecycle, it cannot be cultured on artificial media.
Most Chlamydia infections tend to remain around their sites of inoculation, however, these serotypes can infect regional lymph nodes and proliferate within lymphocytes. The lymphocytes rupture and release infective contents which trigger inflammation in the lymph nodes, which can cause the formation of abscesses and buboes.
Risk Factors
Risk factors include:
- High-risk sexual behaviours (e.g. unprotected sexual intercourse, multiple partners, lack of barrier contraception use)
- HIV
- Men who have sex with men
Presentation
Overview
Infection tends to have three phases:
- First phase – a painless genital papule/ulcer
- Second phase – the ulcer heals and then painful inguinal lymphadenopathy and constitutional symptoms follow
- The affected nodes may coalesce and form abscesses and buboes
- Third phase – proctitis/proctocolitis may develop, which can present similarly to inflammatory bowel disease
Investigations
Overview
Diagnosis is made via nucleic acid amplification tests (NAAT) on genital or lymph node samples.
Management
Overview
Treatment involves the use of doxycycline.
Complications
Scarring and fibrosis – if left untreated, chronic oedema in the genital region can lead to fibrosis and disfiguration. Persistent proctitis/proctocolitis can lead to damage requiring excision and a colostomy and/or strictures and fistulae.
Prognosis
- Early treatment often leads to a full recovery
