Re‐emergence of lymphogranuloma venereum

Abstract

Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by the L1, L2 and L3 serotypes of Chlamydia trachomatis. The disease has been in the spotlight recently because of recent outbreaks in Europe as well as the USA. A unique feature of the recent outbreaks has been that most cases have been caused by the L2 strain. Another unique feature of these outbreaks is the fact that most cases have occurred in men having sex with men, and most patients have presented with proctitis. Interestingly, most recent cases have occurred in human immunodeficiency virus-seropositive patients. Usually, the disease is divided into three phases: the primary stage characterized by a self-healing papule, the secondary stage characterized by proctitis or lymphadenopathy and the tertiary stage characterized by lymphedema and anal strictures. Tests used for diagnosis include polymerase chain reactions and compliment fixation tests. The treatment of choice is doxycycline.

A practical approach to colitis

“…Ano-rectal strictures, peri-rectal abscesses, genital elephantiasis, and esthiomenes (a chronic ulcer) characterize the tertiary stage in longstanding, untreated infections. 17 Endoscopic findings may include hyperaemic, ulcerated, and friable mucosa.…”

“…Though historically a disease of underdeveloped nations, outbreaks have been reported in recent years in the USA, Canada, and Europe, a large proportion of them in HIV-infected MSM. 17 Clinical and endoscopic features: infection is characterized by three stages. The first stage consists of a penile non-tender papule and the secondary stage will present unilateral or bilateral tender inguinal lymphadenitis (Bubo) and/or proctitis.…”

Haemorrhoids, rectal prolapse, anal fissure, peri-anal fistulae and sexually transmitted diseases

“…The rates of rectal gonococcal infections decreased dramatically in the period from 1985 to 1995. However, in Europe and North America, the frequency of proctitis caused by lymphogranuloma venereum (LGV) has increased since 2003, particularly in HIV-infected men [80][81][82][83][84].…”

Suppurative lymphadenitis

“…Examples of these infectious conditions include tuberculous lymphadenopathy [28], bubonic plague (Yersinia pestis) [29], Yersinia enterocolitica infection [30], focal nontyphoid Salmonella infection [31], Legionella pneumophila infection [32•], and sexually transmitted infections such as syphilis [33], chancroid [34], and lymphogranuloma venereum [35].…”