LGV: Lymphogranuloma venereum

LGV, or Lymphogranuloma venereum, is an infection caused by an aggressive strain of Chlamydia called “serovar L”. This strain of Chlamydia is less common in Ontario, but cases are identified each year. Unlike “garden variety” Chlamydia, serovar L Chlamydia causes a more severe infection that spreads into the lymph nodes. In 2015, 40 guys were diagnosed with LGV in Ontario.

LGV progresses through 3 stages. The first stage is mild and appears as a small red bump or ulceration where the bacteria penetrate the skin, typically on the head of the penis, on the foreskin, or inside the anus depending on whether you were topping or bottoming. The lesion appears within 2-14 days of contracting the infection and heals on its own a few days later. During the second stage, the bacteria spread and symptoms become more severe. This typically occurs within 2-4 weeks. If the serovar L Chlamydia is transmitted to the penis, it will spread to the lymph nodes in your groin causing them to swell and become painful. If the bacteria are in the anus, the anus and rectum will become inflamed causing pain, constipation, and anal discharge and bleeding. If untreated, LGV will progress to the third stage, which involves scarring of infected tissue. This will result in water retention in the penis and scrotum causing them to swell. In the rectum, scarring can result in incontinence.

The diagnosis of serovar L Chlamydia requires special tests. Your doctor or nurse may collect a urine sample and insert a swab into your anus. If Chlamydia is detected, the samples can be sent to the National Laboratory in Winnipeg to determine if the Chlamydia is the serovar L type.

LGV is treated with doxycycline, one pill twice a day for 3 weeks. The challenge in treating LGV is that it can take several weeks to obtain test results. Thus, if your symptoms are consistent with LGV, you should be treated for LGV. Treatment should not be delayed while waiting for test results.

Condoms are the best way to prevent LGV. If you have been diagnosed with LGV, you should abstain from all sexual contact for 3 weeks while taking doxycycline to avoid passing the infection on. You should also inform your sexual partners so they can get tested. Anyone you have had sex with within the past 2 months should also be treated with doxycycline.