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Infectious Disease Online

Pathology of Lymphogranuloma Venereum

Dr Sampurna Roy MD





Lymphogranuloma venereum, a sexually transmitted disease of men caused by Chlamydia trachomatis, subgroups L1,  L2, or L3, is characterized by transient primary cutaneous or mucosal lesion and regional lymphadenitis.     


Visit : Syphilis ; Syphilitic Gumma ; Neurosyphilis ; Congenital Syphilis ; Chancroid.


Although the disease is present worldwide, the highest prevalence is in the tropics and subtropics.


It accounts for up to 6% of sexually transmitted disease in Africa, Southeast Asia, and India.


Lymphogranuloma venereum is diagnosed more frequently in men than women, a situation that probably reflects underdiagnosis and asymptomatic disease in women.


In north America and Europe, lymphogranuloma venereum is now primarily a disease of homosexual men.

After an incubation period of 4 to 21 days, a primary lesion develops at the site of infection.

The painless, herpetiform lesion, varying in diameter from 1 to 6 mm, usually occurs on the penis, vagina, cervix, but lips, tongue, and fingers are other primary sites.

Before the primary lesion appears, Chlamydia trachomatis is carried in the lymphatics to regional lymph nodes.

Here after a latent period of 1 to 4 weeks, the nodes enlarge.

Any group may be involved and enlargement may be unilateral or bilateral.

Over the next few weeks, the nodes become tender and fluctuant, and frequently ulcerate and discharge pus.

Lympadenopathy and drainage may persist for several weeks or months.

Involvement of the inguinal and femoral nodes may produce the "groove sign", in  which the enlarged lymph nodes are visibly separated by the inguinal ligament.

Primary anorectal lymphogranuloma venereum, usually in homosexual men, causes severe proctocolitis, accompanied by tenesmus, diarrhea, bleeding, fever, and weight loss.

Patients with lymphogranuloma venereum usually present with lymphadenopathy, with or without systemic signs and symptoms, such as fever, chills, myalgias, arthralgias, headache, anorexia, and meningismus.

Increased serum immunoglobulins, leukocytosis, and elevated erythrocyte sedimentation rate, and abnormal liver function are common.

False-positive reagin tests for syphilis are a feature, but concurrent syphilis always must be considered.

The diagnosis in most cases are made on clinical grounds, supported by serologic tests and is usually confirmed by polymerase chain reaction.

Most infections resolve completely with or without antimicrobial therapy, but there may be serious sequelae.

Progressive ulceration of the penis, urethra, or scrotum, with fistulas and urethral stricture develop in 5% of men with lymphogranuloma venereum.

Chronic ulcers of vulva and smooth, pedunculated, perianal growths are occasional complications.

Lymphatic obstruction develops in 10% to 20%of untreated patients and can cause genital elephantiasis in women.

Rarely, the infection may disseminate to the lungs, kidneys, bones, joints, and brain system, in which case it may be fatal.

Primary cutaneous lesion is a superficial ulcer without specific features.

The lymph nodes contain characteristic multiple, coalescing abscesses, which have the appearance of granulomas.

There are neutrophils and necrotic debris in the center, surrounded by a zone of palisaded epithelioid cells, macrophages, and occasional giant cells.       

In turn, this zone is surrounded by lymphocytes, plasma cells, and fibrous tissue.

Healing is by fibrosis with effacement of the normal architecture of the node.

Lesions outside lymphnodes tend to be dominated by fibrous scarring.

Granulomas in the nodes are identical to cat scratch disease but the bacilli of cat scratch disease, when present in the granulomas, are diagnostic.

Confirmation of a diagnosis of LGV requires showing C. trachomatis serovars L13 by serological tests or PCR on genitourinary specimens.

Lymph node resection is not favoured because of the possibility of sinus formation.

Visit : Psittacosis (Ornithosis, Parrot Fever) ; Trachoma ; Chlamydial Infection  ; Chlamydial Conjunctivitis (Inclusion Conjunctivitis). ; Chlamydial Infection of the Genital Tract  ; Lymphogranuloma Venereum .


Further reading:

The Molecular Diagnosis of Lymphogranuloma Venereum: Evaluation of a Real-Time Multiplex Polymerase Chain Reaction Test Using Rectal and Urethral Specimens.

The emergence of LGV in Western Europe: what do we know, what can we do?

Diagnostic and clinical implications of anorectal lymphogranuloma venereum in men who have sex with men: a retrospective case-control study.

Lymphogranuloma venereum in human immunodeficiency virus-infected individuals in New York City.

Lymphogranuloma venereum proctitis: An emerging sexually transmitted disease in HIV-positive men in the Netherlands.

Lymphogranuloma venereum in Australia.

Slow epidemic of lymphogranuloma venereum L2b strain.

Molecular diagnosis of lymphogranuloma venereum in patients with genital ulcer disease.




Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)



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