Lymphogranuloma Venereum Health Article

Definition

Lymphogranuloma venereum (LGV) is a sexually transmitted systemic disease (STD) caused by a parasitic organism closely related to certain types of bacteria. It affects the lymph nodes and rectal area, as well as the genitals, in humans. The name comes from two Latin words that mean a swelling of granulation tissue in the lymph nodes resulting from sexual intercourse. Granulation tissue is tissue that forms during wound or ulcer healing that has a rough or lumpy surface.

Description

Although LGV is easily treated in its early stages, it can produce serious complications in its later stages. LGV is most likely to occur among people living in tropical or subtropical countries and among military personnel or tourists in countries or large cities with high rates of the disease. Prostitutes play a major role in carrying and transmitting LGV, as was documented during an outbreak in Florida in the late 1980s. There are about 1,000 documented cases of LGV in the United States in an average year.

Causes and symptoms

LGV is caused by Chlamydia trachomatis, a globe-shaped parasitic organism that reproduces only inside of living cells. C. trachomatis has 17 subtypes and is responsible for a wide range of infections in both men and women; however, only subtypes L1, L2, and L3 cause lymphogranuloma venereum. The parasite has a two-part lifecycle. In the first stage, it is inert and can survive outside of cells. In its second stage, it lacks a cell wall and actively reproduces after gaining entry to a cell. As the chlamydia organism reproduces inside the cell, it pushes the nucleus aside and forms an inclusion that can be identified with tissue staining. LGV differs from other diseases caused by C. trachomatis in that it affects the body's lymphatic system and not just the moist tissues of the genital region. In humans, the chlamydia organism is transmitted through vaginal or anal intercourse, oral sex, or contact with fluid from open ulcers or infected tissues.

Lymphogranuloma venereum has three stages. In its primary stage, the disease is more likely to be detected in men; it may go unnoticed in women. After an incubation period of four to 30 days, a small painless ulcer or blister develops in the genital area. Second-stage LGV develops between one and six weeks later. In this stage, the infection spreads to the lymphatic system, forming buboes (swellings) in the lymph nodes of the groin area.

The buboes often merge, soften, and rupture, forming sinuses and fistulas (hollow passages and ducts) that carry an infectious bloody discharge to the outside of the body. Patients with second-stage LGV may also have fever, nausea, headaches, pains in their joints, skin rashes, and enlargement of the spleen or liver. Third-stage LGV, which is sometimes called anogenitorectal syndrome, develops in about 25% of patients. In men, this stage is usually seen in homosexuals. Third-stage LGV is marked by rectal pain, constipation, a discharge containing pus or bloody mucus, and the development of strictures (narrowing or tightening of a body passage) in the rectum or vagina.

LGV can have a number of serious complications. C. trachomatis infections of any subtype are associated with long-term fertility problems in women. Strictures in the rectum can completely close off the lower bowel, producing eventual rupture of the bowel and inflammation of the abdominal cavity. The patient can develop chronic abscesses or fistulae in the anal area or in the vagina in women. Long-term blockages in the lymph nodes can produce elephantiasis, a condition in which the patient's upper legs and groin area become greatly enlarged. Patients with chronic LGV infection have a higher risk of developing cancer in the inflamed areas.

Chronic LGV can be reactivated in patients who become infected with the AIDS virus. These patients develop open ulcers in the groin that are difficult to treat.