LGV

What is it?

Lymphogranuloma venereum (LGV), is a curable sexually transmitted infection (STI) caused by a bacterium from the chlamydia family. LGV can infect the genitals, anus, rectum (back passage), throat or lymph glands. LGV is increasingly being identified in gay and bisexual men (especially those also infected with HIV), but is rare in heterosexual men and women in the UK.

It is caught from unprotected anal, vaginal or oral sex with someone who has LGV. Using recreational drugs and having high-risk sex such as group sex and/or fisting (hand is inserted into a partner's rectum) increases the risk of being infected. The bacteria can also be carried from one rectum to another via objects such as sex toys, fingers, enema equipment, condoms or latex gloves. LGV cannot be caught by kissing, sharing towels, nor from swimming pools saunas or toilet seats. Having LGV could make it easier for you to get or pass on HIV.

How does it affect you?

LGV can cause no symptoms, but it commonly causes symptoms, which usually appear 3-30 days after becoming infected.

Most UK LGV infections are found in the male rectum where symptoms include a discharge of mucus and/or blood from the anus/rectum, ulcers or cuts around the anus, pain when they pass a motion or have passive (receptive) anal sex (proctitis). They may be constipated or have loose motions or a feeling that they have not completely emptied their bowels after passing a motion. LGV in the penis might cause an ulcer, discharge and/or pain on passing urine. Lymph glands in the groin are likely to be swollen. LGV in the mouth or throat is rare but it can cause ulcers, sore throat and swollen glands in the neck. In some cases LGV causes a fever (high temperature), fatigue and abdominal pain.

Diagnosis

SHL do not test for LGV, but if your rectal swab comes back positive for chlamydia, you will be referred to a sexual health clinic to confirm what type of chlamydia you have and  whether you have LGV. This may mean having further tests in the clinic.

LGV is identified from a special swab taken from the rectum, but it can be detected from other genital swabs (vagina, penis), genital ulcers, throat swab, urine and/or pus from swollen lymph nodes. As the result of the LGV test can take up to three weeks to come back, your clinic doctor may advise you to start treatment for LGV before the final result is available, based on their clinical assessment of you.

Treatment

LGV is usually treated with an antibiotic called doxycycline taken for three weeks. Sometimes different antibiotics are used. Symptoms should resolve within 1 to 2 weeks of commencing antibiotic therapy, but in those with longstanding infections it may take up to 3–6 weeks.

Some early LGV infections can carry no symptoms when the infection is first found but symptoms might develop prior to or during the initial days of treatment. Ultimately, these symptoms should also settle promptly.

There are no lasting effects, as long as the infection is treated early enough. Longstanding infection or delayed treatment may lead to scarring and swelling of the skin and blockages in the bowel, permanent swelling of the genitals, arthritis and problems with the liver and lungs.

Contacting partners

If you are diagnosed with LGV and have symptoms, you will need to inform sexual partners from within the last four weeks. If you don’t have any symptoms, this “look back” period for contacting partners goes further back to three months and sometimes longer.  Your sexual contacts should be advised to attend a sexual health clinic for testing and may be offered treatment on the day they attend. If you feel unable to inform previous sexual partners one of our Health Advisers will be able to notify them on your behalf without revealing your identity.

Maintaining good sexual health and preventing re-infection

You should not have oral, anal or vaginal sex during your course of treatment and also until your current partner completes their treatment and until both you and your partner’s symptoms have abated. This is to avoid being re-infected and requiring further treatment.

You may need to attend clinic for a follow up visit and sometimes a repeat check will be offered to make sure it has cleared.

If you have been infected with LGV it is possible you may also have another STI. Therefore it is advisable that you have a full sexual health screen for Gonorrhoea, Chlamydia, Syphilis, HIV, Hepatitis B and Hepatitis C.

Previous successful treatment for LGV doesn't make you immune to catching the infection again. In fact, you should consider having another sexual health screen three months after being treated for LGV because there is a higher risk of becoming infected with it or another STI (eg HIV) over the next year.

To protect yourself use condoms. Cover anything which is moved from one rectum to another with a fresh condom (eg sex toys) or fresh latex glove for each new person it enters (for eg fisting), or clean it with warm water and anti-bacterial soap. Enema equipment should not be shared.