Lymphogranuloma venereum - Specialists and Information

Lymphogranuloma venereum occurs primarily in tropical and subtropical regions of Africa, Asia, and Latin America. In the Western world, however, this sexually transmitted disease is relatively rare.

In recent years, however, there has been an increase in cases of lymphogranuloma venereum in Europe and the United States as well. Those affected are mostly tourists returning from the tropics and their sexual partners, as well as gay men. According to the Infection Protection Act (IfSG), there is currently no mandatory reporting requirement for lymphogranuloma venereum in Germany.

The causative agents of lymphogranuloma venereum are serotypes L1–L3 of the bacterial genus Chlamydia trachomatis. This spherical, Gram-negative bacterium, approximately 0.5 micrometers (µm) in size, is sensitive to cold and dehydration.

Transmission of the pathogen therefore occurs almost exclusively through mucosal contact during unprotected sexual intercourse. In Europe, infection occurs primarily through unprotected anal intercourse between gay men.

Serotypes L1–L3 tend to spread throughout the body, causing a systemic infection.

Lymphogranuloma venereum progresses through three stages, with symptoms varying in each stage.

• Stage I: Small ulcers and blisters

In the so-called primary stage (Stage I), the first characteristic symptoms appear no earlier than 3 days and no later than about 3 weeks after infection.

Painless nodules or fluid-filled blisters form in the genital area, which develop into small ulcers. These heal on their own after a few days. 

In men, they appear on the penis, the glans, the foreskin, the rectum, or the urethra. In women, for example, they appear in the vagina or the urethra.

Since the sores are painless, they often go completely unnoticed.

• Stage II: Swollen Lymph Nodes

About 6 weeks after infection, swollen lymph nodes appear on one or both sides in the groin and/or genital area. 

These painful swollen lymph nodes are visible from the outside. The overlying skin sometimes turns blue-red. If left untreated, the swellings can become infected and rupture. 

In addition, accompanying symptoms such as fever, headache, body aches, muscle and joint pain, chills, and nausea may occur.

• Stage III: Chronic Inflammation and Ulcers

If lymphogranuloma venereum remains untreated, the disease can progress to a chronic, so-called tertiary stage (Stage III). 

This is followed by several symptom-free years during which the pathogens continue to spread throughout the body. Chronic inflammation and ulcers develop in the intestinal and genital areas. 

The consequences are:

• Intestinal strictures causing difficulty with bowel movements
• Disruptions in lymphatic drainage leading to chronic lymphedema Swelling of the genital organs
• Abscesses and fistulas

Lymphogranuloma venereum is diagnosed based on both characteristic symptoms and detection of the causative agent. 

The urologist or gynecologist can identify the swollen lymph nodes and ulcers typical of lymphogranuloma venereum during a physical examination.

To confirm the diagnosis, the doctor also takes a swab from the urethra, the rectum, or a lymph node. 

Using this swab, laboratory staff then prepare a cell culture to identify and detect the exact pathogen. 

A blood or urine test can also detect the pathogen responsible for lymphogranuloma venereum.

The pathogen can also be detected through a blood test @ Saiful52 /AdobeStock

Specific antibiotics target and kill the bacterial pathogens.

The following are used:

• Doxycycline
• Tetracycline
• Erythromycin or 
• Azithromycin

The patient must take the antibiotic daily in tablet form for a period of usually 3 weeks. In severe cases of lymphogranuloma venereum, it may also be necessary to administer the antibiotic as an infusion.

Preventing Reinfection

A laboratory test should be performed after completion of antibiotic therapy to ensure that the causative pathogens of lymphogranuloma venereum are no longer present.

To prevent the spread of the infection and reinfection between partners (the “ping-pong effect”), the infected person’s sexual partners should also undergo treatment.

In addition, patients should abstain from sexual intercourse for up to one week after the end of treatment.

If patients in the early stages receive antibiotics promptly and consistently, the infection clears up quickly without causing any long-term damage. 

However, if the infection with lymphogranuloma venereum remains untreated, the disease can lead to painful swelling of the lymph nodes after a few weeks.

After several years, it progresses to a chronic tertiary stage with severe complications and long-term effects. Long-term effects include, for example, intestinal strictures or impaired lymphatic drainage.