Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2022
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2022
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Practice
Open Access

Lymphogranuloma venereum

Eric J. Eckbo, Malcolm Hedgcock and Troy Grennan
CMAJ December 13, 2021 193 (49) E1889; DOI: https://doi.org/10.1503/cmaj.210853
Eric J. Eckbo
Vancouver Coastal Health, Division of Medical Microbiology & Infection Control (Eckbo), University of British Columbia, Faculty of Medicine, Department of Pathology & Laboratory Medicine (Eckbo); Spectrum Health (Hedgcock); British Columbia Centre for Disease Control, STI/HIV Services (Grennan); University of British Columbia, Faculty of Medicine, Division of Infectious Diseases (Grennan), Vancouver, BC
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Malcolm Hedgcock
Vancouver Coastal Health, Division of Medical Microbiology & Infection Control (Eckbo), University of British Columbia, Faculty of Medicine, Department of Pathology & Laboratory Medicine (Eckbo); Spectrum Health (Hedgcock); British Columbia Centre for Disease Control, STI/HIV Services (Grennan); University of British Columbia, Faculty of Medicine, Division of Infectious Diseases (Grennan), Vancouver, BC
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Troy Grennan
Vancouver Coastal Health, Division of Medical Microbiology & Infection Control (Eckbo), University of British Columbia, Faculty of Medicine, Department of Pathology & Laboratory Medicine (Eckbo); Spectrum Health (Hedgcock); British Columbia Centre for Disease Control, STI/HIV Services (Grennan); University of British Columbia, Faculty of Medicine, Division of Infectious Diseases (Grennan), Vancouver, BC
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading

Lympogranuloma venereum (LGV) is an aggressive, sexually transmitted infection caused by specific strains of Chlamydia trachomatis

The L1, L2, and L3 strains are more invasive than those causing most anogenital infections.1–4 Before 2004, LGV was rare in Canada, but has since become endemic. Between 2013 and 2020, 2052 C. trachomatis isolates forwarded to the National Microbiology Laboratory tested positive for LGV-causing strains (Dr. Alberto Severini, National Microbiology Laboratory, Winnipeg: personal communication, 2021). Outbreaks continue in Western Europe and North America, and primarily affect men who have sex with men.2–6

Lympogranuloma venereum can have variable presentations that can be misdiagnosed

Though LGV can be asymptomatic, the most common presentation is proctitis syndrome, whereby direct anal inoculation results in painful hemorrhagic proctitis, often mimicking inflammatory bowel disease.1–6 In inguinal syndrome, however, infection usually begins with a painless papule, and subsequently progresses to ulceration and inguinal lymphadenopathy.1,4 Systemic symptoms, such as fever, malaise and arthralgia, are often present.2–6

People with symptoms suggestive of LGV, or risk factors, should be tested for C. trachomatis using a nucleic acid amplification test (NAAT)

Swabs should be inserted 2 to 3 cm into the anal canal; alternatively, swabs can be collected by direct visualization during anoscopy. Lymph node aspirates and swabs of suspicious genital lesions can also be sent for NAAT. In many Canadian centres, rectal swabs positive for C. trachomatis will automatically undergo further testing for LGV serovars.

Treatment for LGV is longer than for other forms of chlamydia

Canadian guidelines1 recommend oral doxycycline (100 mg, twice a day) for 21 days as first-line treatment. A test of cure should be performed 3 weeks after completion of treatment. Left untreated, LGV can lead to irreversible tissue destruction, scarring, fistulae and lymphatic obstruction.1–6

Sexual partners should be treated empirically with the same regimen as a diagnosed case, pending test results

All sexual partners within 60 days of a patient’s symptom onset should also be tested for LGV; those who test positive require further clinical follow-up, including test of cure and public health investigation.

Acknowledgments

The authors thank Dr. Alberto Severini and the staff of the Viral Exanthemata and STD Program at the National Microbiology Laboratory for providing national testing data.

Footnotes

  • Competing interests: Troy Grennan reports institutional funding from Merck and Gilead, outside the submitted work. No other competing interests were declared.

  • This article has been peer reviewed.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/

References

  1. ↵
    Canadian guidelines on sexually transmitted infections. Ottawa: Public Health Agency of Canada; 2020. Available: https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/chlamydia-lgv.html (accessed 2021 Jan. 4).
  2. ↵
    1. Weiss E,
    2. Sano M
    . Proctocolitis caused by lymphogranuloma venereum. CMAJ 2018;190:E331–3.
    OpenUrlFREE Full Text
    1. Williamson DA,
    2. Chen MY
    . Emerging and reemerging sexually transmitted infections. N Engl J Med 2020;382:2023–32.
    OpenUrl
  3. ↵
    1. Mabey D,
    2. Peeling RW
    . Lymphogranuloma venereum. Sex Transm Infect 2002;78:90–2.
    OpenUrlAbstract/FREE Full Text
    1. Boutin CA,
    2. Venne S,
    3. Fiset M,
    4. et al
    . Lymphogranuloma venereum in Quebec: re-emergence among men who have sex with men. Can Commun Dis Rep 2018;44:55–61.
    OpenUrl
  4. ↵
    1. Cole MJ,
    2. Field N,
    3. Pitt R,
    4. et al
    . Substantial underdiagnosis of lymphogranuloma venereum in men who have sex with men in Europe: preliminary findings from a multicentre surveillance pilot. Sex Transm Infect 2020;96:137–42.
    OpenUrlAbstract/FREE Full Text
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 193 (49)
CMAJ
Vol. 193, Issue 49
13 Dec 2021
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Lymphogranuloma venereum
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Lymphogranuloma venereum
Eric J. Eckbo, Malcolm Hedgcock, Troy Grennan
CMAJ Dec 2021, 193 (49) E1889; DOI: 10.1503/cmaj.210853

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Lymphogranuloma venereum
Eric J. Eckbo, Malcolm Hedgcock, Troy Grennan
CMAJ Dec 2021, 193 (49) E1889; DOI: 10.1503/cmaj.210853
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Lympogranuloma venereum (LGV) is an aggressive, sexually transmitted infection caused by specific strains of Chlamydia trachomatis
    • Lympogranuloma venereum can have variable presentations that can be misdiagnosed
    • People with symptoms suggestive of LGV, or risk factors, should be tested for C. trachomatis using a nucleic acid amplification test (NAAT)
    • Treatment for LGV is longer than for other forms of chlamydia
    • Sexual partners should be treated empirically with the same regimen as a diagnosed case, pending test results
    • Acknowledgments
    • Footnotes
    • References
  • Responses
  • Metrics
  • PDF

Related Articles

  • Lymphogranulomatose vénérienne
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Endometrial osseous metaplasia with secondary infertility
  • Bell palsy
  • The monkeypox virus
Show more Practice

Similar Articles

Collections

  • Article Types
    • Five Things to Know About
  • Topics
    • Family medicine, general practice, primary care
    • Infectious diseases
    • Internal medicine
    • Public health
    • Sexually transmitted infections

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
  • Accessibiity
  • CMA Civility Standards
CMAJ Group

Copyright 2022, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

Powered by HighWire