Lymphogranuloma venereum

Lymphogranuloma venereum (LGV) is a rare but serious sexually transmitted infection caused by invasive serovars (L1, L2, L3) of *Chlamydia trachomatis*. The disease occurs in several phases and mainly affects the lymphatic system in the genital and rectal areas. It is most common in men who have sex with men (MSM), especially in the presence of HIV infection.

Ways of transmission

- Sexual contact – vaginal, anal, oral (less common)
- Can be transmitted through microtraumas in the skin and mucous membranes
- Increased risk if you have an STI or HIV

Phases of the disease

**1. Primary stage:**
- A small, painless ulcer or papule at the site of infection (penis, vagina, anus)
- Often goes unnoticed and heals spontaneously within days
**2. Secondary stage (after 2–6 weeks):**
- Painful enlargement of the inguinal or femoral lymph nodes (so-called "buboes")
- Lymph nodes can merge, become infected, and open to the skin
- In anal transmission – proctitis (pain, bleeding, purulent discharge, tenesmus)
- Often accompanied by fever, chills, and fatigue
**3. Late (chronic) stage:**
- Formation of fistulas, strictures, rectal stenosis
- Genital deformity and permanent lymphatic disorder

Diagnosis

- PCR test for *Chlamydia trachomatis* from urethral, rectal or lesion material
- Specialized tests for serovar differentiation (not always available)
- Serology – in addition to the clinical picture
- Exclusion of other STIs: syphilis, gonorrhea, herpes, HIV

Treatment

- First choice: doxycycline
- Alternative: erythromycin or azithromycin (according to the doctor's schedule and discretion)
- Drainage of abscessed lymph nodes – if necessary, but carefully
- Treatment of all sexual partners in the last 60 days