Lymphogranuloma venereum

LGV is a sexually transmitted infection (STI) caused by one of three invasive serovars (L1, L2 or L3) of Chlamydia trachomatis.

‘Classic’ LGV is a condition endemic in heterosexuals in areas of Africa, India, S.E. Asia and the Caribbean where it manifests as genital ulcer disease and lymphadenopathy (without proctitis).

LGV re-emerged in Europe in 2003 with subsequent outbreaks in major cities across the European area, the largest of which has been in the UK with 5302 diagnosis reported by the end of 2016. 99.7% were made in men. In Scotland, although there was an increase from an annual diagnosis of 11 from 2012 to 2015 to 45 during 2016, and 23 cases in 2017 transmission of this infection has not become well established in our MSM population. LGV infection is associated with high levels of concurrent STIs, in particular HIV, and high risk sexual behaviour including multiple anonymous partners.

Most patients in the European outbreak have presented with proctitis; symptoms included rectal pain, anorectal bleeding, mucoid and/or haemopurulent rectal discharge, tenesmus, diarrhoea or altered bowel habit and other symptoms of lower gastrointestinal inflammation. Some patients reported systemic symptoms such as fever and malaise. Asymptomatic infection can occur.

Genital ulcers and inguinal symptoms are less common; nonetheless ‘‘classical’’ LGV has been reported in MSM in the European outbreak and clinicians need to be alert for these presentations. Several cases of pharyngeal LGV have also been reported.

Genital ulcers and inguinal symptoms are less common; nonetheless ‘‘classical’’ LGV has been reported in MSM in the European outbreak and clinicians need to be alert for these presentations. Several cases of pharyngeal LGV have also been reported.

For more information
https://edinburghlabmed.co.uk/Specialities/reflab/sbstirl/Pages/default

It is important that clinicians are aware of the process within their service for requesting LGV testing. Processes are likely to vary across services and may include stating on the original request that the sample is to be tested for LGV if CT positive, or liaising with the local lab when a positive CT is reported and the patient merits LGV testing. Testing will contribute to epidemiological monitoring of the LGV outbreak and assist with the management of contacts.

Whenever LGV is confirmed or suspected, the case should be discussed with a clinician experienced in the management of LGV. The management of LGV is beyond the scope of this guidance. Refer to BASHH 2013 UK National Guideline for the Management of Lymphogranuloma Venereum and 2019 European Guideline on the Management of Lymphogranuloma Venerum.

1. British Association of Sexual Heath and HIV Clinical Effectiveness Unit BASHH 2015 UK
   National Guideline for the Management of Infection with Chlamydia trachomatis (2015).
   https://www.bashhguidelines.org/media/1192/ct-2015.pdf [accessed 4th August 2022]
2. Update on the treatment of Chlamydia trachomatis (CT) infection BASHH Clinical
   Effectivesness Group September 2018 [accessed 4th August 2022] https://www.bashhguidelines.org/media/1191/update-on-the-treatment-of-chlamydia-trachomatis-infection-final-16-9-18.pdf [accessed 4th August 2022]
3. British Association of Sexual heath and HIV Clinical Effectiveness Unit BASHH UK National Guideline for the Management of Lymphogranuloma Venerum (2013) https://www.bashh.org/documents/2013%20LGV%20guideline.pdf [accessed 4th August 2022]
4. 2019 European Guideline on the Management of Lymphogranuloma Venereum
   https://onlinelibrary.wiley.com/doi/full/10.1111/jdv.15729 [accessed 4th August 2022]
5. UK National Guidelines for the Management of Pelvic Inflammatory Disease 2018
   https://www.bashhguidelines.org/media/1170/pid-2018.pdf [accessed 4th August 2022]
6. United Kingdom National Guideline for the Management of Pelvic Inflammatory Disease
   (2019 Interim Update) https://www.bashhguidelines.org/media/1217/pid-update-2019.pdf[accessed 4th August 2022]
7. Scottish Bacterial Sexually Transmitted Infections Reference Laboratory (SBSTIRL)
   Samples and Request Forms | Edinburgh and Lothians Laboratory Medicine LGV PCR form Dec 20.pdf (edinburghlabmed.co.uk) [accessed 4th August 2022]
8. Dr Kate Templeton, Head of Service, Regional Virus Laboratory Specialist Virology
   Centre, Edinburgh [pers comm. 4th August 2022]