lymphogranuloma

Lymphogranuloma, most commonly referred to as lymphogranuloma venereum (LGV), is a sexually transmitted infection caused by Chlamydia trachomatis serovars L1, L2, and L3. It is characterized by invasion of the lymphatic system, which can lead to regional lymphadenopathy and chronic inflammatory damage if untreated.

Transmission occurs primarily through sexual contact involving genital, anal, or oropharyngeal mucosa. The infection often begins with a small, painless entry lesion on the genitals or perianal area that may go unnoticed or heal spontaneously.

The clinical course typically progresses through stages. After the primary lesion, regional lymphatics become infected, resulting in painful inguinal or femoral lymphadenopathy (buboes). Buboes may suppurate and rupture, forming draining sinuses. In many patients, particularly men who have sex with men, an anogenital syndrome with proctitis, pain on defecation, discharge, and rectal bleeding may predominate. If untreated, chronic inflammation can cause lymphatic obstruction, leading to genital elephantiasis, strictures, and long-term disability.

Diagnosis relies on clinical suspicion in the appropriate epidemiologic context and confirmation by nucleic acid amplification testing (NAAT) from relevant sites, such as genital or rectal samples. Serology can support diagnosis but is not reliable for early detection. The differential includes syphilis, chancroid, herpes, and granuloma inguinale. HIV and other sexually transmitted infections should be screened for, and patients should be counseled on partner notification and testing.

Treatment consists of antibiotics active against Chlamydia trachomatis, with doxycycline 100 mg twice daily for 21 days as the preferred regimen. Alternatives include erythromycin or ofloxacin for those unable to take doxycycline. Public health measures, including partner notification and surveillance, are important components of management.