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Lymphogranuloma venereum

LGV (Lymphogranuloma venereum) in gay and bisexual men

What is LGV?

  • LGV (Lymphogranuloma venereum) is a sexually transmitted infection caused by three strains of the bacterium Chlamydia trachomatis.
  • Until 2004 it was rare in the UK and was mainly seen in travellers returning form abroad.
  • From 2004 outbreaks of LGV occurred in gay men across Europe and the UK.
  • In the UK outbreaks of  LGV occurred amongst gay men in London, Brighton and Manchester
  • LGV usually infects the rectum (back passage) leading to ‘proctitis’ – ulceration, anal pain, bleeding, discharge and constipation. The symptoms can sometimes be severe with fevers and feeling generally unwell.
  • Testing (rectal swab) needs to be done at a specialised sexual health clinic.
  • LGV is easily treated with 3 weeks of antibiotics.
  • Co-infection with HIV and hepatitis C is common and a full STI screen is recommended.

How common is LGV?

  • LGV is common amongst gay men in London particularly in those visiting clubs and saunas.
  • There have been over 1000 infections reported in gay men since the start of the outbreak in 2004 and the infection is continuing to spread.
  • 75% of men with LGV are also HIV positive.

How do you catch LGV?

  • LGV is passed on through unprotected sex – usually anal sex without a condom – but any of the following ways is possible:
    • Anal sex
    • Oral sex
    • Fisting without gloves
    • Using sex toys between partners

What would I notice if I had LGV?

  • Most infections are caught through anal sex –  this leads to inflammation in the rectum or ‘proctitis’:
    • Anal pain
    • Rectal bleeding
    • Rectal discharge
    • Constipation
    • Feeling of wanting to defecate
  • A small painless ulcer may occur at the site of infection – such as rectum, penis or mouth
  • Painful swelling of lymph glands in the groin
  • Feeling flu like with fever and tiredness
  • Symptoms may appear within a few days or up to 4 weeks after infection

How do I get tested for LGV?

  • A chlamydia swab from the rectum (back passage).
  • Specialist sexual health clinics such as the Wolverton routinely screen all gay men for rectal chlamydia.
  • If you had any of the symptoms above and chlamydia was found, the swab would be sent onto a UK reference laboratory for a special LGV test.

How is LGV treated?

  • With a 3 week course of antibiotics:
    • Doxycycline 100mg twice daily for 3 weeks.
  • All treatments from the Wolverton Centre are free and are given to you in the clinic
  • Take doxycycline after food otherwise it make you feel sick.
  • Avoid strong sunlight as it may cause a rash.

What about my partner?

  • LGV is a sexually transmitted infection so it is important your current and recent partners in the last 4 weeks attend a sexual health clinic for testing and treatment.

What problems can untreated LGV lead to?

  • LGV may lead to serious problems in the rectum and lower bowel with acute inflammation, ulceration, fistulae and strictures often mimicking Crohn’s disease.

Will LGV come back again after treatment?

  • LGV quickly clears up with antibiotic treatment but you can easily be re-infected again – so protect yourself by using a condom for all anal sex, gloves for fisting and avoid sharing sex toys.

 More information

http://www.tht.org.uk/informationresources/otherstis/lgv/

www.bashh.org