What is LGV?

Previously considered rare in developed nations, Lymphogranuloma venereum (LGV) is a highly contagious bacterial STI that's caused by a severe form of chlamydia. It's passed on through unprotected vaginal, anal and oral sex in both men and women.

Before 2003, LGV was highly prevalent in parts of Africa, Asia and the Caribbean but relatively unheard of in Europe. However, an outbreak in the Netherlands among gay men led to reported cases in France, Belgium and Germany. By 2004 there were 24 confirmed cases in the UK and year-on-year the numbers are creeping up. According to the Health Protection Authority (HPA), 849 cases were diagnosed between 2003 and 2008. So far the majority of these patients are HIV co-infected and mostly gay men, although it's now also beginning to infect women too.

What are the LGV symptoms?

Despite being caused by the bacterium Chlamydia trachomatis L1 -L3 the symptoms are very different to chlamydia. The infection goes through three stages and symptoms vary depending on which part of the body is infected.

In the first stage - between three days and three weeks of infection - a small blister or sore may appear in the genital area but will disappear after a few days and may even go unnoticed.

Symptoms in the second stage are more obvious. Taking anything from 10 to 30 days, painful enlarged lymph glands (buboes) form in the groin, armpit or neck. There may also be signs of fever, headache, nausea, vomiting, lethargy and pain in the joints, as well as urethritis. If infection is contracted as a result of anal sex, then the glands inside the anus may swell and lead to proctitis (inflammation of the lining of the rectum). Symptoms include constipation, diarrhoea, pain, as well as pus or blood coming from festering ulcers.

The third stage develops over a number of years. The bacteria will cause inflammation, scarring and tissue damage around the genitals and inside the anus. Haemorrhoid-like growths can develop, tissue damage can narrow the rectum, and the genitals can swell to an impractical size.

However, despite these obvious signs, some sufferers will not experience any symptoms or develop through the stages, and yet their infection will still be contagious.

What does LGV look like?

If you notice it, a pimple in the genital area is the first physical sign. Moving through the second and third stage, expect oozing open sores, inflamed growths and huge testicles.

How is LGV treated?

If you've put yourself at risk, go to your nearest genitourinary medicine (GUM) clinic or make an appointment to see your doctor (GP). The doctor will take a sample from the urethra, rectum, or vagina and send it off to the laboratory for testing. If a patient has swollen glands, a sample of pus may also be taken for testing. The test will initially be for chlamydia, and if this proves positive, a further specific test for LGV will be carried out. Sexual partners of someone diagnosed with LGV will also be given this specific test.

A regular chlamydia infection can be treated with a one-off dose of an antibiotic (azythromycin or doxycycline) for one week. However, LGV requires a three-week course of the antibiotic doxycycline. In severe cases, it may be necessary to drain or surgically remove the buboes or abscesses.

What if I ignore it?

Left until the highly destructive third stage, LGV can lead to inflammation in the rectal and genital areas, with severe swelling and ulcers causing long-term pain and bowel problems. The swelling and scarring in the groin can be permanent.

If ignored completely, the infection can cause more serious health issues, such as arthritis, chest and liver problems. In very severe cases it causes inflammation of the heart or brain, but this is rare.

How do I protect myself from contracting LGV?

Using a condom every time you have sex - including messing around with sex toys - offers a large degree of protection.

Having had LGV before does not provide immunity, so regular screening for STIs are advised for anyone with a number of sexual partners and anyone with LGV-type symptoms.

How soon can I have sex again?

Wait until you have finished your treatment and both you and your partner get the all clear. After diagnosis and treatment your GP may want to carry out a 'test of cure' to check treatment has been successful.

Updated: 01/11/2010