Lymphogranuloma venereum (LGV)

Lymphogranuloma venereum (LGV)

Infection:  Lymphogranuloma venereum; LGV; Chlamydia trachomatis serovars L1-3

Brief description:

Lymphogranuloma venereum (LGV) is a genital ulcer disease caused by certain serovars (types) of Chlamydia trachomatis.

  • Serovars D-K cause the typical genital Chlamydia STI
  • Serovars L1, L2, L3 cause LGV, which is a more severe inflammatory disease, which can involve the inguinal lymph nodes and ano-rectum.

Globally occurs most commonly in the tropics. In New Zealand is usually seen among men who have sex with men (MSM) and most commonly presents as proctitis.

The diagnosis is difficult to establish clinically and relies on laboratory testing.

Did you know?

Can be mistaken for inflammatory bowel disease e.g. ulcerative colitis. If not recognised and treated can lead to fibrosis and strictures in the anogenital tract.

Who should I test?
  • LGV is difficult to diagnose clinically and requires a high index suspicion.
  • LGV should be suspected in all MSM presenting with proctitis or significant anorectal pain/discharge.
Test of choice:

Request Chlamydia LGV NAAT/PCR

The initial test to diagnose LGV is a standard Chlamydia NAAT/PCR test on an anorectal swab.

  • Excellent sensitivity – a negative test on a well-collected sample excludes LGV.
  • Non-specific – a positive test confirms Chlamydia infection, but doesn’t differentiate between ‘standard’ Chlamydia and LGV

A separate, specific, LGV test is required to confirm LGV.

  • In our laboratory, a positive Chlamydia NAAT from an anorectal swab will automatically have LGV testing added on.
Other considerations:
  • Identification of LGV is important as a longer duration of treatment (3 weeks) than typical genital Chlamydia infection is required for cure
  • All patients diagnosed with LGV should be tested for HIV infection, syphilis, and other STIs.
  • All sexual contacts from the prior 3 months should be offered treatment.