Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by bacteria Chlamydia trachomatis certain variant. This disease usually begins with ulcers (ulcers) on the genitals that heal on their own and swollen lymph nodes in the groin.
LGV can occur along with other sexually transmitted infections, such as HIV. This disease can be experienced by anyone, but is more common in men aged 15-40 years who are sexually active or have same-sex sexual relations.
Causes of Lymphogranuloma Venereum
Lymphogranuloma venereum (LGV) is caused by infection with Chlamydia trachomatis bacteria types L1, L2, and L3. Although both are caused by the bacterium C. trachomatis, the cause of LGV is different from the bacteria that cause chlamydia or chlamydia. Chlamydia is caused by the type D-K bacteria C. trachomatis.
Bacterial infection C. trachomatis LGV attacks the lymphatic system (lymph). This infection can be transmitted through direct contact with ulcers, namely wounds such as ulcers that are quite deep, on the patient's skin. Generally, transmission occurs during sexual intercourse.
LGV can happen to anyone. However, people with the following conditions are judged to be more susceptible to experiencing them:
- Male gender, especially those who have same-sex sexual relations
- 15–40 years old and sexually active
- Frequently changing sexual partners
- Having sex without safety equipment, such as condoms
- Sexual intercourse through the anus (anus) or orally (mouth)
- Using a device that is used in the genital or rectal area alternately, such as an enema (a device for inserting medicine through the anus)
Symptoms of Lymphogranuloma Venereum
Symptoms of LGV are divided into 3 stages according to the sequence of events, namely:
Stage 1
Stage 1 symptoms can appear about 10–14 days after a person is infected. Symptoms in stage one are small, shallow ulcers in the genital area or mouth where the infection-causing bacteria have come into contact.
The sores can also gather so that herpes is often suspected. These sores are painless and can disappear in a few days. As a result, the symptoms of stage 1 LGV often go unnoticed.
Stage 2
Stage 2 symptoms occur about 2–6 weeks after stage 1 symptoms. Stage 2 symptoms can include:
- Swollen lymph nodes in the groin (buboes) and in the lymph nodes in the neck if the transmission is done orally
- Disorders in the anal and rectal area, such as pain in the anus, pain when urinating and defecating, constipation, bleeding in the rectum, until the bowel movements are incomplete (tenesmus)
- General disorders, such as headache, not feeling well, fever, nausea, vomiting, to joint pain
At this stage, some patients may not be aware of the occurrence of LGV because the above symptoms can be similar to some other diseases. For example, disorders of the anal area are similar to the symptoms of ulcerative colitis.
Stage 3
Stage 3 symptoms usually only appear when the infection does not go away. The delay in the appearance of stage 3 symptoms is very diverse, it can even appear up to 20 years after the patient is first infected with LGV.
Symptoms at stage 3 can include:
- Abscess or collection of pus in the area of infection
- Anal fistula
- Edema or swelling of the lymph nodes and genital area
- Tissue death and lymph node rupture
- Changes in gender
- Infertility or infertility
When to go to the doctor
Check with your doctor if you experience the symptoms mentioned above. It is important to know the condition of the disease as early as possible so that it can be treated immediately and to prevent complications.
It is also necessary to check with a doctor for a partner with LGV because this disease has the potential to be transmitted through sexual intercourse. Checks are important to prevent the spread of the disease.
People who frequently change sexual partners and do not use protection during intercourse are more likely to develop LGV. Therefore, this at-risk group needs to be screened for sexually transmitted infections on a regular basis.
Diagnosis of Lymphogranuloma Venereum
To diagnose LGV, the doctor will ask the patient's complaints and symptoms, as well as the patient's medical history, especially about the history of sexual intercourse. After that, the doctor will perform an examination in the anal and genital area.
If necessary, the doctor will also perform a series of supporting tests to confirm the diagnosis of LGV. Some of the checks that can be done are:
- Serological blood test, to detect the presence of antibodies that the body produces when experiencing a bacterial infection C. trachomatis
- Inspection direct immunofluorescence assay, to determine the presence of body antibodies in Chlamydia trachomatis
- Culture Chlamydia trachomatis, to determine the presence of these bacteria through the study of fluid and tissue samples from lymph nodes
- Nucleic Acid Amplification Test (NAAT), to determine the presence of bacteria through a swab sample from urine or infected area tissue
- Scanning with a CT scan, to see the condition of the infection in more detail and assess whether it has the potential to develop into cancer
A thorough screening for other types of infectious diseases, such as syphilis, HIV, and hepatitis C, may also be recommended by your doctor to help confirm the diagnosis.
Lymphogranuloma Venereum Treatment
Treatment of lymphogranuloma venereum aims to treat bacterial infection and prevent complications. This can be done in the following ways:
Administration of antibiotics
Some types of antibiotic drugs that can kill bacteria to treat LGV are:
- Doxycycline can be given at a dose of 100 mg twice a day for 21 days
- Erythromycin can be given at a dose of 500 mg 4 times a day for 21 days
- Azithromycin can be given at a dose of 1 gram once a week for 3 weeks
- Moxifloxacin, usually given if the patient is resistant to doxyxcycline
Other antibiotics may be given if the patient also has other bacterial infections, such as syphilis or gonorrhea.
Pus discharge
This procedure is performed when swollen lymph nodes contain pus or recur frequently. The procedure is done by making a small incision in the swollen area of skin and sucking or draining the pus inside.
Operation procedure
Surgery can be performed if the patient has experienced severe symptoms, such as anal fistulas and genital deformities. Surgery may also be an option if symptoms cannot be treated with antibiotics. In severe conditions, surgical removal of the lymph nodes may also be performed.
Safe sex education
During the treatment period, the doctor will also provide advice about safe sex so that the condition does not occur again. Doctors generally advise patients not to change sexual partners.
In addition, doctors will advise patients to always wear safety devices, such as condoms, during sexual intercourse.
To prevent further spread of the disease, patients are expected to inform their sexual partners of their condition within 60 days of the first symptoms appearing. The patient's sexual partners also need to be screened for sexually transmitted infections and take antibiotics.
LGV treated earlier has a higher cure rate. Relapse is possible if the patient is only diagnosed when the condition is severe.
Complications of Lymphogranuloma Venereum
Various symptoms in stage 3 can also be classified as complications of LGV. In addition to these symptoms, a number of other complications can also arise if LGV is not treated, namely:
- Pelvic inflammation in women
- Conjunctivitis
- Arthritis
- Pericarditis
- Pneumonia
- Inflammation of the brain and meninges
- Hepatomegaly
Prevention of Lymphogranuloma Venereum
Having safe and healthy sex is the main step to prevent the transmission of LGV. This can be done in the following ways:
- Don't change partners
- Using safety devices, such as condoms, during sexual intercourse
- Clean the genitals before and after sexual intercourse
- Do not share the use of personal items, such as towels or clothes
- Screening for sexually transmitted infections regularly if you have already been diagnosed or are at risk of developing them
