Lymphogranuloma Venereum (LGV): Causes, Symptoms, and Treatment

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Lymphogranuloma venereum (LGV) is a sexually transmitted systemic infection caused by the Chlamydia trachomatis bacterium that targets the lymph nodes in the groin area. Its symptoms include small painless sores that appear in the genital area, followed by painful, tense swellings in the groin lymph nodes. Its treatment is provided through long-term antibiotic use planned under physician supervision and, when necessary, minimal clinical interventions that relieve pressure in the lymph nodes. In this condition, which progresses by infiltrating the lymphatic channels deep within the body, early diagnosis is the most critical step in preventing permanent damage to the tissues and completely eliminating the infection from the body.

Definition	Lymphogranuloma venereum (LGV) is a sexually transmitted invasive infection caused by the L1, L2, and L3 serovars of the Chlamydia trachomatis bacterium. It can affect genital, anal, and lymphatic tissues; if left untreated, it may lead to chronic complications.
Causative Agent	Chlamydia trachomatis serovars L1, L2, and L3
Route of Transmission	It is transmitted through unprotected vaginal, anal, or oral sexual contact. It spreads through direct contact with infected lesions and mucous membranes.
Risk Factors	Unprotected sexual intercourse, multiple sexual partners, men who have sex with men (especially anal contact), HIV infection, and the presence of other sexually transmitted infections.
Incubation Period	Usually 3–30 days.
Stages of the Disease	Primary stage (small genital ulcer or papule), secondary stage (painful lymph node enlargement and systemic symptoms), tertiary stage (chronic inflammation, fibrosis, and lymphedema).
Most Commonly Affected Areas	Penis, vulva, vagina, cervix, urethra, rectum, anus, and groin lymph nodes.
Primary Stage Findings	A small, usually painless papule, vesicle, or superficial ulcer develops. The lesion can often heal without being noticed.
Secondary Stage Findings	Painful enlargement of the groin lymph nodes (bubo), fever, fatigue, muscle aches, and headache. In anal infections, rectal pain, bloody discharge, mucus in the stool, and proctocolitis may develop.
Tertiary Stage Findings	Chronic lymphedema, genital deformities, fibrosis, fistulas, anal narrowing, chronic proctitis, and permanent tissue damage may occur.
Symptoms	Genital ulcer, painful swelling in the groin, fever, fatigue, rectal pain, pain during defecation, anal discharge, bleeding, constipation, or tenesmus.
Physical Examination Findings	Tender and enlarged lymph nodes in the groin, fluctuant buboes, genital ulcers, inflammation in the anal region, and signs of proctitis.
Diagnosis	Clinical evaluation, nucleic acid amplification testing (NAAT/PCR) for Chlamydia trachomatis, LGV serovar identification in appropriate samples, and exclusion of other sexually transmitted infections.
Laboratory Findings	Detection of Chlamydia trachomatis by PCR; serological tests may be helpful in some cases, but they are not diagnostic on their own.
Differential Diagnosis	Syphilis, genital herpes, chancroid, donovanosis, reactive lymphadenitis, anal fissure, inflammatory bowel diseases, anal cancer, and other causes of proctitis.
Treatment	Doxycycline therapy is the first choice. Alternatively, erythromycin or azithromycin may be used in some cases. Treatment must be arranged according to the physician’s recommendation.
Duration of Treatment	Standard treatment usually lasts 21 days.
Surgical Intervention	Aspiration may be performed when necessary for buboes. Extensive surgical drainage is generally not recommended because it may increase the risk of fistula formation.
Treatment During Pregnancy	Doxycycline is not used during pregnancy. The appropriate antibiotic is selected by the physician according to the pregnancy status.
Complications	Chronic lymphedema, genital elephantiasis, fistula formation, anal stenosis, chronic proctocolitis, genital damage that may contribute to infertility, and permanent scar tissue.
Relationship with HIV	It can occur together with HIV and may have a more severe or atypical course, especially in HIV-positive individuals. Genital ulcers may increase the risk of HIV transmission.
Sexual Partner Management	It is recommended that partners with whom sexual contact has occurred within the last 60 days be evaluated, tested, and treated when appropriate.
Prevention Methods	Condom use, safe sexual intercourse, regular sexual health screenings, avoiding sexual contact when symptoms develop, and early diagnosis and treatment.
Follow-up	Improvement of symptoms after treatment is evaluated. Retesting may be performed when necessary, and screening for other sexually transmitted infections is recommended.
Recovery Process	With early diagnosis and appropriate antibiotic treatment, the infection can heal completely. Fibrosis and lymphedema that develop in cases diagnosed late may be permanent.
Risk of Recurrence	Reinfection is possible. New unprotected sexual contact after treatment increases the risk of infection.
When Should a Doctor Be Consulted?	If there is a genital ulcer, painful swelling in the groin, rectal pain, anal bleeding or discharge, unexplained fever, or suspicion of a sexually transmitted infection, a healthcare facility should be consulted without delay.
Prognosis	The prognosis is generally good with early diagnosis and appropriate treatment. When treatment is delayed, chronic lymphatic damage, deformity, and permanent loss of function may develop.

What Is Lymphogranuloma Venereum (LGV)?

In addition to blood circulation, the human body contains a vast highway network called the lymphatic system, which carries immune cells and collects excess fluid from the tissues. The L1, L2, and L3 subtypes of the chlamydia bacterium, which causes lymphogranuloma venereum (LGV), aim to enter this highway network. After the bacterium enters the body, rather than remaining on the surface, it quickly infiltrates these lymphatic channels.

The bacterium travels along the lymphatic channels and reaches the lymph nodes, which can be thought of as checkpoints along the route. When it encounters the body’s defense cells there, an intense battle begins. This inflammation process creates the conditions for the lymph nodes to swell excessively, the channels to become blocked, and the structure of the tissues in that area to deteriorate over time. The infection usually spreads regionally, beginning from the area where contact occurred, and may become chronic at the tissue level if left untreated. This progression specific to the lymphatic system is the most fundamental feature that distinguishes the disease from standard infections.

Factors contributing to the progression of the process are as follows:

• Delayed diagnosis
• Non-compliance with treatment
• Weakened immunity
• Concurrent infections

Who Is at Higher Risk of Lymphogranuloma Venereum (LGV)?

One of the most striking points in the spread of this condition is that a large proportion of individuals carrying the infection do not experience any symptoms. Evaluations show that more than half of carriers go through an asymptomatic period, meaning they have no complaints. This means that a person can transmit the infection to others without knowing it. Patients who apply to clinics and receive a diagnosis actually represent only a very small portion of the general carrier group in society.

Its incidence is particularly more pronounced among younger age groups and people with active social lives. Although it is detected slightly more frequently in men than in women, the main reason may be that men notice the symptoms more quickly and apply to healthcare institutions earlier. Low public awareness, lack of regular screening, and acting on hearsay are among the conditions that increase the risk rate.

The main risk groups are as follows:

• Young adults
• People with multiple partners
• Those who do not use protection methods
• Individuals with weakened immunity

What Are the Primary Stage Symptoms of Lymphogranuloma Venereum (LGV)?

The disease usually develops in three distinct stages. After suspicious contact, the incubation period of the bacterium may range from a few days to one month on average. At the end of this period, the primary stage begins. A very small lesion that does not cause pain and is usually overlooked appears in the area where the bacterium entered the body. This lesion may appear as a slightly raised pimple on the skin, a tiny fluid-filled blister, or a very small superficial sore.

The most deceptive aspect of this initial sore is that it causes no discomfort to the person. Since there is no itching, burning, or pain, the patient may confuse the condition with temporary problems such as simple skin irritation or an ingrown hair. Moreover, this sore heals and disappears on its own within a few days. When the person sees that the sore has gone away, they think they have recovered and do not feel the need to consult a specialist. However, the closure of the sore does not mean that the infection has ended; on the contrary, the bacterium has only just begun its journey deeper into the lymphatic system.

The main characteristics of the primary stage are as follows:

• Painless sore
• Small swelling
• Short-term appearance
• Spontaneous closure

What Complaints Occur in the Secondary Stage of Lymphogranuloma Venereum (LGV)?

After the primary stage passes silently, the secondary stage, the most pronounced period of the disease, begins within a few weeks. When the bacterium reaches the lymph nodes in the groin area and begins to multiply there, very noticeable swelling and tenderness occur in that region. The person usually notices a one-sided, hard mass in the groin that causes severe pain when touched and grows day by day. These masses can make daily life, walking, and movement considerably difficult.

This stage has a very typical medical finding. When the lymph nodes both below and above an anatomical ligament in the groin area swell at the same time, a depression forms in the skin along the line where that ligament passes. This condition, which creates a distinct groove-like appearance from the outside, is medically called the “groove sign.” Over time, the inflammation inside these enlarged lymph nodes increases, the skin over them becomes tense, and takes on a purplish or reddish color. If appropriate medical support is not obtained at this stage, the excessively stretched tissue may perforate on its own and create a draining tract opening through the skin.

The findings observed in the secondary stage are as follows:

• Swelling in the groin
• Tenderness to touch
• Skin discoloration
• Groove sign
• Difficulty walking

What Happens If Lymphogranuloma Venereum (LGV) Progresses to the Tertiary Stage?

If the disease remains unnoticed for months or years, is incorrectly assessed, or the person avoids seeking medical support, the process may progress to the tertiary stage. At this stage, also called the late stage, the infection has become chronic and has begun to cause structural changes in the tissues that may be considered permanent. If the bacterium reaches the final part of the large intestine and the lymphatic network around the anus, the process becomes much more debilitating.

The person may develop complaints that deeply disrupt quality of life, such as difficulty defecating, unexplained anal bleeding, chronic pain, and inflammatory discharge. Due to impaired lymphatic circulation, continuously recurring abscesses may form around the anus, along with tunnels called fistulas that open externally from different points of the skin. This stage is the period in which patients are most physically and psychologically exhausted because body functions are greatly affected and adapting to daily life becomes difficult.

The symptoms of the tertiary stage are as follows:

• Chronic pain
• Inflammatory discharge
• Recurring abscesses
• Changes in bowel habits

Are the Complications of Lymphogranuloma Venereum (LGV) Different in Women and Men?

The effects left by the disease in the body may vary between women and men due to differences in anatomical structures. In women, the infection may spread to the deeper parts of the reproductive organs. This condition may cause inflammation in the uterus and fallopian tubes, creating the basis for blockage of the tubes. Blocked tubes may increase the risk of ectopic pregnancy in women planning a future pregnancy or make it difficult to become pregnant.

In men, the infection mainly affects the urinary tract and groin lymph nodes. Chronic inflammation occurring in the urinary canal may cause narrowing of these channels over time. A narrowed urinary tract weakens urine flow and may lead to pressure problems that can extend to the kidneys. In both sexes, although rarely, joint inflammation called reactive arthritis, characterized by swelling and pain in the joints, may occur as a general immune response of the body to the infection.

Possible complications are as follows:

• Blockage in the tubes
• Risk of ectopic pregnancy
• Urinary tract narrowing
• Joint pain

How Is Lymphogranuloma Venereum (LGV) Diagnosed in a Urology Clinic?

When a patient applies to a urology clinic with these complaints, the process first begins with a comfortable and detailed conversation based on mutual trust. Listening to the patient’s history and understanding when the complaints began is the most important part of the diagnosis. During the subsequent physical examination, the condition and size of the lymph nodes in the groin area and the structure of the skin are examined. After evaluating the clinical findings, the physician uses laboratory tests to clarify the condition.

Today, highly advanced genetic screening tests are used to detect this condition. A small swab sample taken from the area where the lesion is located or from the swollen lymph node is sent to the laboratory. Using the PCR (Nucleic Acid Amplification Test) method applied there, the genetic material of the bacterium is sought. This method is much more sensitive than many other tests and greatly assists in establishing the diagnosis. When deemed necessary, the body’s defense response against this bacterium can also be measured by examining antibody levels in the patient’s blood.

The tests requested in the clinic are as follows:

• Regional swab
• Lymph fluid sample
• Genetic PCR test
• Blood test

Can Lymphogranuloma Venereum (LGV) Be Confused with Other Diseases?

Swelling of the groin lymph nodes and the formation of sores in the genital area are not findings specific only to this condition. There are many different types of infections that cause similar complaints. Therefore, extreme care is taken during the diagnostic stage, and other possibilities are reviewed. Conditions such as syphilis, genital herpes, or chancroid may create similar lesions at first glance.

This process, called differential diagnosis, is critically important to prevent the initiation of an incorrect treatment plan. For example, a painless sore may also occur in syphilis, but the nature of the lymph node swelling is different. In herpes infections, fluid-filled blisters are usually painful. To prevent this confusion, some additional tests may be requested from the patient. In addition, when a sexually transmitted infection is detected, screening the patient for other possible infections to assess their general health status is also part of the physician’s routine.

Conditions that may be confused with it are as follows:

• Syphilis
• Herpes
• Chancroid
• Simple ingrown hair

What Interventions Are Performed for Enlarged Lymph Nodes in Lymphogranuloma Venereum (LGV)?

Large and tense lymph nodes that develop in the groin during the secondary stage of the disease may cause serious discomfort to the patient. When these nodes gradually fill with inflammatory fluid, the skin becomes extremely thin and there is a risk of spontaneous rupture. If these lymph nodes rupture on their own, wounds may form that damage the skin, are very difficult to heal, and continue to drain for a long time. Urology specialists perform certain minor clinical interventions to protect the patient from this condition.

Needle aspiration is the leading intervention. The physician inserts a special needle through healthy skin surrounding the swelling and slowly withdraws the accumulated fluid. This procedure immediately reduces the internal pressure and greatly relieves the pain felt by the patient. It also prevents the skin from tearing. In abscesses that are too dense to be drained with a needle and do not respond to medication, a very small incision may be made to clean the area. Such interventions contribute significantly to the recovery process.

The local interventions performed are as follows:

• Needle aspiration
• Pressure reduction procedure
• Minor drainage
• Dressing applications

Which Surgeries Are Performed for Advanced-Stage Lymphogranuloma Venereum (LGV) Damage?

When the disease remains untreated for years and begins to show the destructive effects of the tertiary stage, deterioration may occur in the natural anatomy of the organs. More comprehensive surgical interventions may be planned by urology specialists to repair this serious structural damage occurring in the urinary canals, pelvic area, or lymphatic system. The main purpose of these operations is to repair damaged tissues and enable the patient to perform daily bodily functions more comfortably.

For example, when chronic narrowing in the urinary canal makes urination difficult, the aim is to open these strictures using closed methods (endoscopic). In women, abnormal connections (fistulas) formed between the bladder and other organs are attempted to be closed surgically. In the most severe cases, if excessive swelling and deformities have developed in the genital area due to blockage of the lymphatic system, reconstructive surgery may be performed in which excess tissues are removed and the area is reshaped. These operations may help improve the patient’s quality of life and enable them to participate more comfortably in social life.

The surgical options are as follows:

• Canal dilation
• Fistula repair
• Tissue reshaping
• Cleaning of the edematous area

Which Medications Are Preferred in the Treatment of Lymphogranuloma Venereum (LGV)?

The main treatment of the disease is, of course, the use of medical drugs that target the bacterium. Since this bacterium tends to settle inside cells and penetrates deep into the tissues, short-term medications used for simple infections are generally insufficient. Therefore, physicians arrange a much more planned, disciplined, and long-term antibiotic treatment.

In the method considered the gold standard of treatment, antibiotic protocols that generally need to be used regularly for 21 days are preferred. This long treatment lasting three weeks supports the substantial elimination of the bacterium from the body and helps stop the disease from progressing to advanced stages. However, if the patient has special circumstances such as an allergy, pregnancy, or inability to tolerate the medication, the physician may replan the process using different antibiotic groups and dosage schedules. The success of treatment is directly related to adherence to the duration and dose recommended by the physician.

The approaches used in treatment are as follows:

• Three-week pill use
• Alternative antibiotics
• Weekly single-dose regimens
• Regular clinical follow-up

What Should Be Done to Prevent Lymphogranuloma Venereum (LGV)?

The most effective way to control the spread of this condition and protect individual health is to establish awareness of protection and take partner treatment seriously. It is not sufficient for only the individual diagnosed with the infection to receive treatment; it is of great importance that sexual partners with whom the person has recently been in contact are also examined and that necessary preventive treatments are initiated. Including partners in the treatment process is the most critical step in preventing the infection from being transmitted repeatedly to the person, known as the ping-pong effect.

In addition, the use of appropriate barrier methods (condoms, etc.) during sexual contact greatly helps reduce the risk of transmission of such diseases. However, it should be remembered that transmission may also occur from lesions in skin areas not covered by the condom. It is recommended to avoid sexual contact until the treatment process is completely finished and approval is obtained from the physician. From a public health perspective, consulting a healthcare professional without hesitation when a suspicious condition is noticed is the fundamental key to maintaining a healthy life.

The prevention and management steps are as follows:

• Use of barrier methods
• Examination of the partner
• Avoiding contact until treatment is completed
• Regular specialist follow-up

Frequently Asked Questions

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