Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by the L1, L2, and L3 serotypes of the bacterium Chlamydia trachomatis. This disease is usually prevalent in tropical and subtropical regions, but in recent years it has seen an increasing incidence worldwide, especially among men who have sex with men (MSM). If left untreated, LGV can lead to serious complications. Therefore, it is important for individuals showing symptoms of the infection to seek medical help immediately and start appropriate treatment. Paying attention to the methods of protection against sexually transmitted diseases reduces the risk of infection.
What Are the Causes of Lymphogranuloma Venereum?
The symptoms of lymphogranuloma venereum are:
- painless small sores or ulcers
- painful swelling of groin lymph nodes
- rectal pain
- rectal bleeding
- rectal discharge
- constipation
- fever
- muscle aches
- headache
- severe rectal inflammation
What Are the Symptoms of Lymphogranuloma Venereum?
The causes of lymphogranuloma venereum are related to specific serotypes of the bacterium Chlamydia trachomatis and the transmission routes of this bacterium:
Chlamydia trachomatis: LGV is an infection caused by the L1, L2, and L3 serotypes of the bacterium Chlamydia trachomatis.
Sexual Contact: LGV is transmitted through unprotected vaginal, anal, or oral sex with infected individuals. Since it is a sexually transmitted disease, sexual activity is the most common route of transmission.
Direct Contact: Transmission is possible through direct contact with infected areas. This is especially true in cases of open sores or mucosal surfaces in the genital, anal, or oral regions.
High-Risk Sexual Behaviors: Having multiple sexual partners, engaging in unprotected sex, and being infected with other sexually transmitted diseases increase the risk of infection.
Men Who Have Sex with Men (MSM): This group is at higher risk, especially in regions where LGV is common.
History of Sexually Transmitted Infections (STI): Individuals with a history of other sexually transmitted infections may be more vulnerable to LGV infection.
Access Restrictions: Limited access to health services and sexual health education and resources can increase the risk of spreading LGV and other sexually transmitted diseases.
Stigma and Discrimination: Stigmatization related to sexual health can prevent individuals from seeking sexual health services, making the diagnosis and treatment of infections like LGV more challenging.
How to Diagnose Lymphogranuloma Venereum?
The diagnosis of lymphogranuloma venereum is confirmed through clinical symptoms as well as laboratory tests:
Clinical Evaluation: The patient’s symptoms and medical history are taken into account for evaluation.
Physical Examination: Ulcers and other symptoms in the genital or rectal area are examined.
Nucleic Acid Amplification Tests (NAAT): These are tests that detect the DNA of the bacterium Chlamydia trachomatis. These tests are generally performed on urine samples or swab samples taken from the infected area.
Serological Tests: Detecting antibodies in the blood. However, serological tests may be limited in specifically identifying LGV.
Culture: Culturing samples taken from the infected area in a laboratory environment. This method is less common and may take longer.
Rectal Examination and Biopsy: If there are rectal symptoms, the rectal area may need to be examined with anoscopy or sigmoidoscopy.
Tests for Other Sexually Transmitted Infections: It is recommended that the patient be tested for other sexually transmitted infections as LGV often occurs alongside other infections.
How to Treat Lymphogranuloma Venereum?
The treatment of lymphogranuloma venereum is most effective when started in the early stage of the infection:
Doxycycline: It is usually the first-choice antibiotic. Dosage: 100 mg, twice a day, for 21 days.
Erythromycin: It is an alternative treatment option. Dosage: 500 mg, four times a day, for 21 days.
Azithromycin: It can be used as a single dose or in weekly doses.
Tetracycline: Another alternative treatment option. Dosage: 500 mg, four times a day, for 21 days.
Pain and Inflammation Management: Pain relievers and anti-inflammatory drugs can be used to reduce pain and swelling.
Drainage of Buboes: If there are severe lymph node swellings (buboes), surgical drainage may be necessary. However, buboes usually drain on their own.
Surgical Intervention: In severe cases, if fistulas or strictures (narrowing) develop, surgical intervention may be necessary.
Management of Rectal Diseases: If there are rectal proctitis or other complications, additional treatment and surgical intervention may be required.
Partner Notification: The patient’s sexual partners should be informed and evaluated for infection.
Simultaneous Treatment: Treating partners is important to reduce the risk of reinfection.
Follow-up Appointments: The patient should be monitored at regular intervals to assess the effectiveness of the treatment.
Prevention of Reinfection: Information should be provided about sexual health education and protection methods.
Sexual Health Education: Patients should be informed about LGV and other sexually transmitted diseases and taught protection methods.
Protection Methods: The use of condoms should be encouraged and awareness of sexual health should be increased.
How Should the Management of Lymphogranuloma Venereum Be?
The management of lymphogranuloma venereum focuses on early diagnosis of the infection, appropriate treatment, and prevention of complications:
Clinical Evaluation: Symptoms of patients should be recognized early and evaluated considering their sexual history.
Laboratory Tests: NAAT (Nucleic Acid Amplification Tests) and other appropriate tests should be used to confirm the infection.
Antibiotic Treatment: In the treatment of lymphogranuloma venereum (LGV), doxycycline 100 mg is used twice a day for 21 days. Alternatively, erythromycin 500 mg four times a day for 21 days, or tetracycline 500 mg four times a day for 21 days can be given.
Pain and Inflammation Management: Analgesics and anti-inflammatory drugs can be used to reduce pain and swelling.
Drainage of Buboes: If there are severe lymph node swellings (buboes), surgical drainage may be necessary.
Surgical Intervention: If fistulas or strictures develop, surgical intervention may be necessary.
Management of Rectal Diseases: If there are rectal proctitis or other rectal complications, additional treatment and surgical intervention may be required.
Partner Notification: The patient’s sexual partners should be informed and evaluated for infection.
Simultaneous Treatment: Treating partners is important to reduce the risk of reinfection.
Follow-up Appointments: The patient should be monitored at regular intervals to assess the effectiveness of the treatment.
Prevention of Reinfection: Information should be provided about sexual health education and protection methods.
Sexual Health Education: Patients should be informed about LGV and other sexually transmitted diseases and taught protection methods.
Protection Methods: The use of condoms should be encouraged and awareness of sexual health should be increased.
Public Health Surveillance: An effective public health surveillance system should be established for the detection and reporting of LGV cases.
Education of At-Risk Groups: Educational and awareness campaigns should be organized, especially for the MSM (men who have sex with men) community.
Hygiene and Cleanliness: Attention should be paid to the cleanliness and hygiene of infected areas.
Preventive Measures: Healthcare workers should use personal protective equipment when in contact with infected patients.
Psychological Support: Patients should receive psychological support during the diagnosis and treatment process.
Support Groups: The establishment of support groups for individuals with sexual health issues should be encouraged.
