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What is Lymphogranuloma venereum (LGV)?

LGV (Lymphogranuloma Venereum) is a sexually transmitted disease (STD) caused by three strains of Chlamydia trachomatis. When infected with these particular strains, there is development of genital papule(s) (e.g., raised surface or bumps) and/or ulcers, and swelling of the lymph glands in the genital area. LGV may also produce rectal ulcers, bleeding, pain, and discharge, especially among those who practice receptive anal intercourse.

Infection can be often asymptomatic in women and perinatal transmission can rarely occur.
 

Are there cases of LGV in North America and Europe?

There is worldwide distribution of LGV and in particular these strains are prevalent in tropical and subtropical areas. LGV has been thought to be rare in industrialized countries but there have been outbreaks in the Netherlands, other European countries and recently in San Francisco among men who have sex with men.

Because LGV is rare outside of lesions can be mistaken for other ulcerative STDs such as syphilis, genital herpes, and chancroid, so true incidents of LGV is unknown. Complications of untreated LGV may include enlargement and ulcerations of the external genitalia and lymphatic obstruction, which may lead to elephantiasis of the genitalia.
 

If LGV is suspected, what specimens can be sent to the Lab?

There are limitations in commercially available tests for the detection of LGV, the diagnosis if primarily based on clinical findings and risk factors.

How is LGV treated?

LGV can be effectively treated with three weeks of antibiotics, if diagnosed and treated early. Current guidelines recommend doxycycline twice daily for 21 days. Other treatment options include erythromycin or azithromycin. There is no vaccine against the bacteria. All sexual partners of the patient within 60days of the onset of symptoms need evaluation and treatment.
 

What are potential complications of untreated LGV?

Complications of untreated LGV may include enlargement and ulcerations of the external genitalia and lymphatic obstruction, which may lead to elephantiasis of the genitalia.
 


Ontario Public Health Laboratory
Specimen Submission Requirements for Lymphogranuloma Venereum

LGV Diagnostic Testing Reports

The infectious agent associated with Lymphogranuloma venereum (LGV) is Chlamydia trachomatis, serotypes L-1, L-2 and L-3. The following information is to outline preferred specimen types and provide direction for physicians submitting clinical specimens to the Ontario Public Health Laboratories for diagnosing LGV.

 

Specimen type

Swab/aspirate of affected sites, e.g. aspirate of buboe, swab of purulent discharge, and rectal swabs

Collection kit

Chlamydia trachomatis Culture Collection Kit (Starswab™ Multitrans™ media)

Transport requirements

The sample should be transported to the nearest OPHL at 2-9C within 48 hours of collection.

Testing performed

Nucleic Acid Amplification for C. trachomatis Sequencing of C. trachomatis isolates

Results

1. Chlamydia trachomatis NAAT result
2. LGV Sequencing result
 

Specimen type

Blood, clotted or serum

Collection kit

BL-S

Testing performed

Microimmunofluorescence, MIF IgG and IgM

Results

Serological titres reported with interpretation.
 
 
  • Both a swab/aspirate and serum specimen should be submitted from patients suspected of having LGV.
  • Requests for LGV testing are forwarded to the National Microbiology Laboratory in Winnipeg, Manitoba.
  • Specimens unsuitable or suboptimal for the detection of LGV include commercial NAAT swabs or urines submitted for Nucleic Acid Amplification testing.

For further information or to order collection kits please contact your nearest Ontario Public Health Laboratory or the Bacterial STD Laboratory in Toronto at 416-235-5704.

Emergency Duty Officer: (416) 605-3113
Helpline: 1-800-640-7221