Lymphogranuloma venereum LGV ; also known as Climatic bubo ,  Durand—Nicolas—Favre disease ,  Poradenitis inguinale ,  , Lymphogranuloma inguinale , and Strumous bubo  is a sexually transmitted disease caused by the invasive serovars L1, L2, L2a, L2b, or L3 of Chlamydia trachomatis. LGV is primarily an infection of lymphatics and lymph nodes. Chlamydia trachomatis is the bacteria responsible for LGV. It gains entrance through breaks in the skin, or it can cross the epithelial cell layer of mucous membranes. The organism travels from the site of inoculation down the lymphatic channels to multiply within mononuclear phagocytes of the lymph nodes it passes. In developed nations, it was considered rare before
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The detection of herpes, chancroid, and syphilis in genital ulcers is done by PCR. This is not so for lymphogranuloma venereum LGV. Our findings suggest that the clinical description of LGV in current textbooks is incomplete. Current textbooks divide lymphogranuloma venereum LGV into three stages 7 , The primary stage is characterized by small, painless herpetiform genital ulcers which are often not recognized and resolve spontaneously.
The secondary stage is characterized as lymphadenopathy, mostly without a genital lesion. Inguinal lymphadenitis with or without a history of genital lesions is therefore the characteristic presentation 11 , 12 , The use of NAATs is the preferred method to diagnose herpes, chancroid, and syphilis, but these tests are rarely applied to diagnose LGV. One study used a PCR targeting the cryptic plasmid without further analysis 9 , and one used sequence analysis of major outer membrane protein gene amplicons 1.
The lack of sensitive and specific diagnostic tests is likely responsible for the wide variation in prevalence of LGV in patients with genital ulcer disease GUD reported from Africa 2 , 5 , 6. Biovar identification of C. A PCR with restriction digestion of the product to distinguish between the C. The study cohort was the same as that in the treatment efficacy study 13 and included consecutive consenting patients presenting with GUD at the Prince Cyril Zulu Communicable Diseases Clinic in Durban between October and April All infections except granuloma inguinale were diagnosed by PCR The study was approved by the Ethics Committee of the Nelson R.
Mandela School of Medicine. Demographics and clinical presentation of male and female patients with genital ulcer disease with and without LGV a. Specimen collection and preparation have been described previously Lane 1, molecular weight marker; lane 10, undigested bp product; lanes 2 and 9, digested products and bp of C. The number of inclusion bodies per ml in the undiluted culture was established by immunofluorescence microscopy MicroTrak; Trinity Biotech, Wicklow, Ireland.
Six randomly selected PCR products with LGV biovar restriction patterns and one with a trachoma biovar restriction pattern were sequenced. Sequence reactions were done by using the BigDye terminator cycle-sequencing ready reaction kit Applied Biosystems, Foster City, Calif. Products were analyzed on an ABI analyzer. Groups were compared by use of Wilcoxon nonparametric tests for numeric data and the chi-square test or Fisher's exact test for categorical data. This is in keeping with what has been reported previously Identified sequences matched those of the CrP gene of C.
For two specimens both from male patients , the signal obtained with the CrP-PCR-D was repeatedly faint and the restriction pattern was considered unreliable. Of the remaining 64, 63 were positive for LGV and 1 positive for the trachoma biovar. These lymph nodes had no particular features, e. Patients included in this study all had primary LGV.
Early publications acknowledge the difficulty in differentiating LGV lesions from chancroid lesions 3 , 7 , 8 , 10 , while current textbooks compare LGV lesions with genital herpes lesions 11 , This change in the description of the lesions over time may have resulted from the application of MIF as the standard diagnostic test. Being an antibody detection test, MIF is likely to produce positive results only with cases of advanced disease.
Although changes in clinical presentation of LGV due to HIV infection cannot be excluded, the similarity between our findings and the early descriptions 3 , 7 , 8 , 10 suggests that this is not the sole explanation. In conclusion, the presence of C. Willem Sturm.
National Center for Biotechnology Information , U. Journal List J Clin Microbiol v. J Clin Microbiol. Patrick D. Author information Article notes Copyright and License information Disclaimer. Phone: Fax: E-mail: az. This article has been cited by other articles in PMC. Abstract The detection of herpes, chancroid, and syphilis in genital ulcers is done by PCR.
TABLE 1. Open in a separate window. Significant P values are shown in bold. Bauwens, J. Orlander, M. Gomez, et al. Epidemic lymphogranuloma venereum during epidemics of crack cocaine use and HIV infection in the Bahamas. Behets, F. Andriamiadana, D. Randrianasolo, et al. Chancroid, primary syphilis, genital herpes, and lymphogranuloma venereum in Antananarivo, Madagascar. Brandt, R. The dependability of the skin test in the diagnosis of lymphogranuloma venereum and chancroid, especially in the colored race.
Clinical Effectiveness Group. National guideline for the management of lymphogranuloma venereum. Coovadia, Y. Kharsany, and A. The microbial aetiology of genital ulcers in black men in Durban, South Africa. Dangor, Y. Fehler, F. Exposto, and H.
Causes and treatment of sexually acquired genital ulceration in southern Africa. Durand, N. Nicolas, and M. Lymphogranulomatose inguinale, subaigue d'origine genitale probable, peut-etre venerienne. Societe Medicale des Hospitaux de Paris, Seance du 31 janviere Paris 35 : Frei, W.
Eine neue hautreaktion bei lyphogranuloma venereum. Htun, Y. Morse, Y. Dangor, et al. Comparison of clinically directed, disease specific, and syndromic protocols for the management of genital ulcer disease in Lesotho. Jersild, P. Les intradermo-reactions dans le chancre mou et dans la lymphogranulomatose inguinale considerees specialement dans leurs rapports avec etiologie du syphilome ano-rectale. Syphilome : Jones, R. Chlamydia trachomatis , p. Bennett, G.
Mandell, and R. Dolin ed. Churchill-Livingstone, New York, N. Mabey, D. Sexually transmitted diseases excluding HIV , p. Cook ed. Saunders, London, United Kingdom.
Moodley, P. Sturm, T. Vanmali, D. Wilkinson, C. Connolly, and A. Association between HIV-1 infection, the etiology of genital ulcer disease and response to syndromic treatment. Schachter, J.
Molecular Diagnosis of Lymphogranuloma Venereum in Patients with Genital Ulcer Disease
This is because its symptoms are relatively mild and can even, at times, go unnoticed. Lymphogranuloma venereum, or just LGV, is an aggressive form of chlamydia. Unlike chlamydia, LGV symptoms are very noticeable and painful. Fortunately, LGV is also much more rare than regular chlamydia.
Forme pseudo-tumorale de lymphogranulomatose vénérienne: à propos d'un cas
These five consecutive cases aim to highlight the risk of LG misdiagnosis, in case of initial presentation with isolated inguinal adenitis. One patient had clinical signs of urethritis. None presented an associated rectitis. Urinary polymerase chain reaction PCR was positive for the symptomatic patient and negative for the others.
Lymphogranuloma venereum LGV is an uncommon sexually transmitted disease caused by the L serovars of Chlamydiae trachomatis. Since —, a continued outbreak of LGV proctitis C. All lesions resolved after a three-week course of doxycycline mg daily. Clinical descriptions of male genital LGV are infrequent, even during the LGV proctitis epidemic seen in Western countries in recent years. A diagnosis of LGV must be considered in the presence of sexually transmitted genital lesions, even atypical, especially among HIV-infected patients. Elawar, M.