iSymptom

ConditionInfections

Lymphogranuloma Venereum (LGV)

Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by invasive strains (L1, L2, L3) of Chlamydia trachomatis. Unlike ordinary chlamydia, LGV spreads into lymph tissue. It may start with a small painless genital sore, followed by painful swollen lymph nodes in the groin, or, after anal sex, inflammation of the rectum (proctitis) with pain, discharge and bleeding. In high-income countries it occurs mostly in men who have sex with men. A 3-week course of doxycycline cures it.

Also called: LGV, lymphogranuloma inguinale, climatic bubo, Durand-Nicolas-Favre disease, tropical bubo

By the iSymptom editorial team · Updated · 4 min read

At a glance

What it is
An invasive form of chlamydia infection that involves lymph nodes.
Who gets it
Mostly men who have sex with men in the US and Europe; endemic in parts of Africa, Asia, South America and the Caribbean.
Symptoms
Small painless sore, then painful groin swelling (buboes), or proctitis with rectal pain, discharge and bleeding.
Diagnosis
Chlamydia NAAT on a swab, with LGV-specific genotyping where available.
Treatment
Doxycycline for 21 days; treat sexual partners from the past 60 days.

When to get help

See a doctor within a day or two

  • Rectal pain, bloody or mucus discharge, or pain with bowel movements after anal sex
  • Painful swelling of groin lymph nodes, especially if red or draining
  • Fever and feeling unwell with genital or rectal symptoms

Book a routine appointment

  • A painless genital or anal sore that healed on its own
  • A sexual partner diagnosed with LGV or chlamydia
  • Ongoing rectal symptoms diagnosed as inflammatory bowel disease, if you have had anal sex (LGV can mimic it)
  • Regular STI testing if you have new or multiple partners

How LGV differs from ordinary chlamydia

Common genital chlamydia (strains D to K) infects the surface lining of the urethra, cervix, rectum or throat and often causes no symptoms. LGV strains invade deeper into tissues and spread through lymphatic vessels to lymph nodes, causing more inflammation and potential scarring. The same NAAT test detects both, but specific genotyping is needed to confirm LGV.

Transmission

LGV spreads through vaginal, anal or oral sex, and possibly through shared sex toys or fisting. Since the 2000s, outbreaks in Europe, North America and Australia have mainly involved men who have sex with men, often with rectal infection and frequently alongside HIV or other STIs.

Stages and symptoms

Primary stage (3 to 30 days after exposure)

  • a small, painless papule, blister or ulcer on the penis, vulva, vagina, cervix, anus or rectum
  • it often heals within days and goes unnoticed

Secondary stage (2 to 6 weeks later)

Inguinal (groin) syndrome, more common after genital exposure:

  • painful, swollen lymph nodes in the groin, usually on one side (buboes)
  • the "groove sign": swollen nodes above and below the inguinal ligament
  • nodes may become soft and burst, draining pus
  • fever, chills, aches and fatigue

Anorectal syndrome, after receptive anal sex:

  • proctitis: rectal pain, discharge (mucus or pus), bleeding
  • tenesmus (feeling of needing to pass stool) and constipation
  • fever
  • often mistaken for inflammatory bowel disease

Tertiary stage (if untreated)

  • chronic inflammation causing scarring, fistulas, rectal strictures
  • genital elephantiasis from blocked lymph drainage (esthiomene)
  • rarely, frozen pelvis

Diagnosis

  • Chlamydia NAAT on swabs from the sore, rectum, urethra or vagina, or on lymph node aspirate. A positive rectal chlamydia test with proctitis symptoms is treated as LGV.
  • LGV genotyping to confirm L1 to L3 strains, available in some public health and reference laboratories.
  • Testing for other STIs: HIV, syphilis, gonorrhea, hepatitis B and C, herpes.
  • Anoscopy or sigmoidoscopy may show inflamed, ulcerated rectal lining.

Treatment

  • Doxycycline twice daily for 21 days is the recommended treatment.
  • Alternatives: erythromycin or azithromycin regimens (azithromycin is used in pregnancy, with test of cure).
  • Buboes: may need needle aspiration or incision to relieve pain and prevent rupture.
  • Strictures and fistulas may need surgery.
  • Avoid sex until treatment is complete and symptoms have resolved.
  • Partners: anyone who had sexual contact with the patient within 60 days before symptoms should be tested and treated.
  • Retest about 3 months after treatment because reinfection is common.

Complications

  • rectal strictures and fistulas
  • chronic genital swelling and lymphedema
  • increased HIV transmission risk
  • infertility, ectopic pregnancy and chronic pelvic pain in women with upper genital tract involvement

Prevention

  • condoms and barriers for anal, vaginal and oral sex
  • not sharing sex toys, or using new condoms on them
  • regular STI testing, including rectal and throat swabs when relevant
  • doxycycline post-exposure prophylaxis (doxy-PEP) for some at-risk groups, as recommended by CDC, reduces chlamydia and syphilis

Frequently asked questions

What is lymphogranuloma venereum?

LGV is a sexually transmitted infection caused by invasive strains of chlamydia. It can cause a small genital sore, painful swollen groin lymph nodes, or rectal inflammation with pain, discharge and bleeding. It is cured with a 3-week course of antibiotics.

Is LGV the same as chlamydia?

LGV is caused by special strains of Chlamydia trachomatis that spread into lymph tissue. Ordinary chlamydia stays on the surface lining and is treated with a 7-day course. LGV needs longer treatment and can cause more serious complications if untreated.

What are the symptoms of LGV proctitis?

LGV proctitis causes rectal pain, a feeling of needing to pass stool, mucus or pus discharge, bleeding, constipation and sometimes fever. It can look like inflammatory bowel disease. A rectal chlamydia test helps make the diagnosis.

Can LGV be cured?

Yes. Doxycycline taken for 21 days cures LGV. Complications that have already developed, such as strictures or fistulas, may need additional treatment. Sexual partners should also be tested and treated to prevent reinfection.

Sources

This guide was written from current patient and clinical guidance, including:

  • CDC: Sexually Transmitted Infections Treatment Guidelines, lymphogranuloma venereum
  • CDC: Chlamydia, detailed fact sheet
  • British Association for Sexual Health and HIV (BASHH): UK national guideline for LGV
  • WHO: Guidelines for the management of symptomatic STIs
  • MedlinePlus: Lymphogranuloma venereum