Penis and scrotum
Infectious disorders
Lymphogranuloma venereum

Authors: Antonio Cubilla, M.D., Alcides Chaux, M.D. (see Authors page)

Revised: 29 March 2018, last major update February 2010

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PubMed Search: Lymphogranuloma venereum penis

Cite this page: Cubilla, A., Chaux, A. Lymphogranuloma venereum. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/penscrotumLGV.html. Accessed November 14th, 2018.
Epidemiology
Etiology
  • Sexually transmitted disease caused by Chlamydia trachomatis, an intracellular bacteria
  • Different genovars produce specific clinical manifestations; i.e. types A, B, Ba and C cause trachoma, types LGV I, II and III (serovars L1, L2 and L3) cause LGV and types D to K cause oculogenital diseases
Clinical features
  • Causes either inguinal, rectal or rarely pharyngeal syndrome
  • Inguinal syndrome: painless papule or ulcer at inoculation site appears and rapidly disappears; followed 1 - 2 weeks later by enlarged inguinal lymph nodes with suppurative inflammation; followed by lymphocytic hyperplasia and massive plasma cell infiltration; then get stellate abscess; then suppurative granuloma with sinuses and tracts
  • Rectal syndrome: most patients have proctitis, many with severe symptoms (Clin Infect Dis 2007;44:26)
  • LGV infection may facilitate transmission of HIV
  • Diagnosis: based primarily on clinical findings, can be supported by culture (30 - 50% sensitive), complement fixation (80% sensitive but does not distinguish different serovars) or PCR (limited availability)
Treatment
  • Tetracycline (except during pregnancy) or erythromycin
Clinical images

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Sinus tract

Microscopic (histologic) description
  • Nonspecific features of ulceration and granulation tissue in dermis
  • Suppurative inflammation of inguinal lymph nodes (neutrophils in necrotic foci); followed by lymphocytic hyperplasia and massive plasma cell infiltration; then stellate abscess from merging of microfoci of suppuration; then suppurative nonnecrotizing granuloma with epithelioid and multinucleated giant cells
  • Sinuses and tracts can develop and fibrosis may ultimately replace most of lymph node architecture
  • In lymph nodes, appear as intravacuolar organisms, associated with necrosis and suppuration
  • Etiological agent is not apparent with routine stains
  • Organisms are 0.2 - 2.0 micrometers in diameter, stain Gram negative with the Brown-Hopps tissue Gram stain, faintly blue with hematoxylin and eosin stain and black with Warthin-Starry stain (Mod Pathol 1995;8:924)
Microscopic (histologic) images

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Lymph nodes

Electron microscopy description
  • Elementary and reticulate bodies and intermediate forms characteristic of the genus Chlamydia