Lymphogranuloma venereum (LGV)
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What is LGV?
Lymphogranuloma venereum is a highly contagious sexually transmitted infection caused by bacteria. This infection originated in tropical climates, and is endemic in Central and South America, some regions of Africa and the Caribbean. In 2003, LGV first surfaced in gay communities in developing countries. (The first reported case appeared in Montreal in January 2004).
How do you get LGV?
- From anal, oral and vaginal sexual relations with an infected person;
- Inserting fingers or the fist into the anus (fisting);
- Using unclean or unsanitary sex toys (dildo, butt-plug, anal enema, etc.) Sex toys should never be shared;
- From sexual relations with several partners without using a new condom or glove for each partner.
What are the symptoms of LGV?
Lymphogranuloma venereum (LGV) is a bacterial infection that causes sores on the penis, vagina and vulva, and occasionally in the cervix and anus. These sores may serve as entry points for other sexually transmitted infections (STI), such as HIV, Hepatitis A, B and C, and other blood-borne infections.
First stage (Primary LGV)
A small painless sore (shallow ulcer or lump) may appear 3 to 30 days after sexual contact, in the area where the LGV bacteria first entered the body (mouth, urethra or glans penis). It can often go unnoticed, unless it is in the urethra, whereupon the infection can cause a burning sensation during urination. In the first stage, symptoms may disappear and go unnoticed.
Second stage (Secondary LGV)
Between 2 and 6 weeks after initial contact with the germ, you may develop an infection in your lymph nodes (often in the groin) causing pain and fever. Fewer than one patient in three may develop abscesses, fistulas and pus-filled discharge. You may also experience headaches. A period of general malaise (fever, chills, fatigue, loss of appetite, muscle and joint pain) may also occur.
Third stage (Tertiary LGV)
Untreated LGV is a serious infection which can cause severe health problems. Excrescences or hemorrhoid-like growths may appear around the anus. The genitals may also become infected, and emergency surgery may be necessary to remove abscesses. In women, the third stage results in scarring and permanent damage to the genital area.
What are the possible complications of LGV?
- Shrinking or perforation of the rectum or colon;
- Severe swelling or deformity of the genitals;
- In men: inflammation of the urethra;
- In women: inflammation of the cervix with vaginal discharge;
- In rare cases, LGV can cause inflammation of the liver or of a joint; it may also cause hepatitis, or even death;
- Other rare complications may also occur.
How is LGV diagnosed?
LGV can be difficult to diagnose, and is identified when health-care professionals ask patients questions about their medical histories. There is no specific test for LGV.
A health-care professional may take a urine sample and/or a mucus sample from a woman’s cervix or a man’s urethra. Samples may be taken from the throat or rectum, and a blood test may also be performed.
What is the treatment for LGV?
LGV can be treated easily if detected early.
A health-care professional will prescribe a treatment plan for you. LGV is treated with antibiotics, taken for three weeks. All sex partners you had in the last 60 days before your symptoms first appeared must be informed and treated as well.
If you are in the third stage of LGV, you may need surgery, followed by 4 to 6 weeks of antibiotics. Plastic surgery may be necessary afterwards.
How can LGV be prevented?
- Use a condom or other barrier method during sexual relations (vaginal, anal and oral sex).
- Reduce or avoid sexual activities that can cause mucosal lesions (e.g. ‘fisting’), since these can spread transmission of the disease. Do not share sex toys; if sex toys are shared, be sure to disinfect them before use.
- Change your condom or glove when you change partners.
What are the risks for HIV-positive people?
LGV infection sometimes lasts longer in people who have HIV (the AIDS virus).
Since LGV lesions are entry and exit points for viruses, people who have this infection:
- can more easily catch HIV or other sexually transmitted infections when they have unprotected sexual relations;
- if they already have HIV, can transmit the AIDS virus when they have unprotected sex.
Reporting of LGV has recently become compulsory in Quebec.* Therefore, doctors who diagnose LGV must inform the Public Health Department of their region.
A public health professional will offer support in identifying and informing sexual partners up to 6 weeks prior to the appearance of the first symptoms. If the person with gonorrhea is asymptomatic, sexual partners from even earlier must also be informed.
*Outside Quebec, similar public health laws apply.