Anus & perianal area


Lymphogranuloma venereum

Last author update: 1 September 2014
Last staff update: 28 March 2024 (update in progress)

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PubMed Search: Lymphogranuloma venereum anus

Arvind Rishi, M.D., M.B.B.S.
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Cite this page: Rishi A. Lymphogranuloma venereum. website. Accessed April 14th, 2024.
Definition / general
  • Sexually transmitted chronic ulcerative disease
  • Causative organism Chlamydia trachomatis L1, L2, and L3 serovars
  • Complications: strictures, perirectal abscess, fistulas and sinuses, squamous cell carcinoma
  • Rectal strictures are more common in women
  • Three stages of infection:
    • Primary infection:
      • Small often unnoticed ulceration, erosion or erythematic area
      • Usually self healing
      • Incubation period of 3 - 12 days following an exposure to the causative organism
    • Secondary infection:
      • Due to the extension of infection to the draining lymph nodes
      • LGV causing serovars produce severe disease with systemic symptoms as compared to serovars A to K
      • Manifests 2 - 6 weeks after primary infection
      • Characterized by enlarged and painful lymph nodes
      • Lymph nodes may rupture and form cutaneous sinuses
      • Anorectal disease presents as GI bleed, discharge, rectal ulcer, anal pain or constipation
      • Clinically and histologically mimics inflammatory bowel disease
    • Late infection:
      • Complications of longstanding disease in the form of strictures, fistulas, genital lymphedema and infertility
  • Endemic disease in the tropical and subtropical regions of Asia, Africa, South America and Africa
  • Increased incidence in western population, especially men who have sex with men (MSM)
  • Associated coinfections:
    • Up to 76% also infected with HIV (Clin Infect Dis 2007;44:26)
    • Other sexually transmitted disease in 39%
    • Hepatitis C infection in 20%
  • Rectum (LGV proctitis)
  • Perianal skin
  • Draining lymph nodes
  • Mainly involves lymphatic system causing lymphangitis, necrosis and abscess formation
  • Produces more generalized lymphoproliferative response
  • Binds through heparan sulfate receptors
  • Recombination of serovars had been reported between serovars L2 and D in cases with hemorrhagic proctitis (MBio 2011;2:e00045)
  • Culture of the organism
    • Sampling by direct aspirate from the infected lymph node, perianal swab or rectal swab
    • Positive culture is confirmatory but the yield is usually low
    • Culture is positive in 20 - 30% of cases and depends on the stage of the illness
    • Most common positive culture is during the secondary stage of illness
    • Primary stage is usually missed for sampling because of subtle clinical feature
    • Chlamydia cultures are not widely available and are done only at referral centers
  • Serology
    • Complement fixation test and immunofluorescence test
    • Complement fixation test measures antibody against group specific lipopolysaccharide antigen
    • Serological tests are supportive only in the presence of appropriate clinical findings
    • Rising titer is significant for the presence of the disease
    • Titer of greater than 1:64 is considered supportive
    • Limitation:
      • Cannot distinguish recent from past infection
      • Cannot distinguish individual serotypes
      • Limited diagnostic potential in an isolated site infection
  • Nucleic acid amplification test (NAAT)
    • A polymerase chain reaction (PCR) based test
    • Sensitivity and specificity greater than 95%
    • Ease of sampling (swab) and transport of the specimen
    • Routine additional testing following a positive NAAT screening test for C. trachomatis no longer recommended by CDC
Case reports
Clinical images

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Groove sign (squamous cell carcinoma, not LGV)

Microscopic (histologic) description
  • Granulomatous proctitis resembling Crohn's disease
  • Follicular infiltrates of lymphocytes, histiocytes and plasma cells, neural hyperplasia, extensive fibrosis
  • See also Lymph nodes - Lymphogranuloma venereum
Microscopic (histologic) images

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C. trachomatis inclusion bodies (brown)

Differential diagnosis
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