Lymphogranuloma venereum is a sexually transmitted disease caused by a certain variant of the Chlamydia trachomatis bacterium . This disease usually begins with ulcers on the genitals and swollen lymph nodes in the groin.
Lymphogranuloma venereum or lymphogranuloma venereum can occur with other sexually transmitted infections , such as HIV. This disease can happen to anyone, but it is more common in men aged 15–40 years who are sexually active, both with women and with other men.
Causes of Lymphogranuloma Venereum
Lymphogranuloma venereum (LGV) is caused by infection with Chlamydia trachomatis 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. Chlamydia is caused by the bacterium C. trachomatis type DK.
C. trachomatis bacterial infection in LGV attacks the lymph nodes. This infection can be transmitted through direct contact with an ulcer, which is a wound like an ulcer that is quite deep in the skin. Generally, transmission occurs during sexual intercourse, either through the vagina, anal (anus), or orally (mouth).
Risk factors for lymphogranuloma venereum
LGV can happen to anyone. However, people with the following conditions are considered more susceptible to experiencing it:
- Male sex, especially those who have same-sex sex
- Age 15–40 years and sexually active
- Suffering from HIV/AIDS
- Frequently changing sexual partners
- Having unprotected sex, such as a condom
- Have anal or oral sex
- Using tools that are used in the genital area or rectum alternately, such as a device for inserting drugs through the rectum (enema)
Symptoms Lymphogranuloma Venereum
LGV symptoms are divided into three stages according to the sequence of events, namely:
Stage 1 symptoms can appear about 10–14 days after a person is infected. Symptoms of stage one are small, shallow ulcers in the genital area or mouth where contact with the bacteria that causes the infection occurs.
These sores can also gather so that they are often suspected of herpes . These sores are painless and disappear within a few days. As a result, the symptoms of stage 1 LGV are often not noticed.
Stage 2 symptoms occur about 2–6 weeks after stage 1 symptoms. Stage 2 symptoms can include:
- Swollen lymph nodes in the groin ( buboes ), as well as in the lymph nodes in the neck if the transmission is carried out orally
- Disorders in the anal and rectal area, such as anal pain, pain during urination and defecation, constipation , bleeding in the rectum, until bowel movements feel like they are incomplete (tenesmus)
- General disturbances, such as headaches, feeling unwell, fever, nausea, vomiting, to joint pain
At this stage, some patients may not be aware of LGV, because the symptoms at this stage can be similar to several other diseases. For example, irritation in the anal area is similar to the symptoms of ulcerative colitis .
Stage 3 symptoms usually only appear when the infection is not being treated. Symptoms in stage 3 can include:
- Abscess or collection of pus in the area of infection
- Fistula years
- Narrowing of the anal canal
- Tension in the pelvic muscles
- Edema or swelling of the lymph nodes and genital area
- Tissue death and lymph node rupture
- Sex change
- Infertility or infertility
When to see a doctor
Check with your doctor if you experience the symptoms mentioned above. It is important to detect the disease as early as possible. That way, LGV can be treated immediately and the risk of complications due to LGV can be prevented.
Because this disease has the potential to be transmitted through sexual intercourse, it is also necessary to see a doctor if your partner has symptoms of LGV. The goal is to prevent the spread of disease.
People who frequently change sexual partners and do not use protection during sex are more likely to experience LGV. Therefore, this risk group needs to regularly screen for sexually transmitted infections.
Diagnosis Lymphogranuloma Venereum
To diagnose LGV, the doctor will ask about the symptoms experienced, as well as the patient's medical history, especially the history of sexual intercourse. After that, the doctor will examine the rectal and genital area.
If needed, the doctor will also carry out a series of supporting examinations to confirm the diagnosis. 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 Trachomatis bacterial infection
- Nucleic Acid Amplification Test (NAAT), to detect the presence of bacteria through a swab sample from urine or infected area tissue
- Direct immunofluorescence assay examination , to determine the presence of body antibodies to Chlamydia trachomatis
- Chlamydia trachomatis culture , to determine the presence of LGV bacteria through examination of fluid and tissue samples from the lymph nodes
- 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
Thorough screening for several other types of infectious diseases, such as syphilis , HIV, and hepatitis C , may also be recommended by a doctor to help confirm the diagnosis.
Treatment of Lymphogranuloma Venereum
Treatment of lymphogranuloma venereum aims to treat bacterial infections and prevent complications. This can be done in the following ways:
Administration of antibiotics
Several types of antibiotic drugs that can eradicate bacteria to treat LGV are:
- Doxycycline at a dose of 100 mg twice a day for 21 days
- Erythromycin at a dose of 500 mg 4 times a day for 21 days
- Azithromycin at a dose of 1 gram once a week for 3 weeks
- Moxifloxacin, usually given when the patient is resistant to doxyxcycline
Other antibiotics may be given if the patient also has another bacterial infection, such as syphilis or gonorrhea.
Production of pus
This procedure is performed when the swollen lymph nodes are filled with pus and often recur. This procedure is performed by making a small incision in the swollen area of the skin, then suctioning or draining the pus in it.
Surgery can be performed if the patient has experienced severe symptoms, such as anal fistulas and changes in sex shape. Surgery may also be an option if symptoms cannot be treated with antibiotics.
In severe conditions, lymph node removal surgery may also be an option.
Education on how to have safe sex
During the treatment period, the doctor will also provide advice regarding safe sexual relations so that this condition does not recur. Doctors generally advise patients not to have multiple sexual partners.
In addition, the doctor will advise the patient to always use a safety device, such as a condom, when having sex.
To prevent the spread of the disease from spreading further, patients are expected to inform their sexual partners of their condition within 60 days of the first symptoms appearing. The patient's partner also needs to undergo screening for sexually transmitted infections and take antibiotics.
LGV that is treated earlier has a greater percentage of cure. Recurrence may occur if the patient is newly diagnosed when the condition is already severe.
Complications of Lymphogranuloma Venereum
Various symptoms in stage 3 can also be classified as a complication of LGV. Apart from these symptoms, a number of other complications can also arise if LGV is not treated, namely:
- Pelvic inflammation in women
- Inflammation of the brain and meninges
- Lymph node necrosis and damage
- Fistula years
- Scar tissue on the penis
- Swelling in the genital area in the long term
Meanwhile, in patients with lymphogranuloma venereum (LGV) who are pregnant, babies who are born can experience conjunctivitis .
Prevention of Lymphogranuloma Venereum
Having safe and healthy sex is the main step to prevent LGV transmission. This can be done in the following ways:
- Not changing partners
- Using protection, such as condoms, during sexual intercourse
- Clean the genitals before and after sexual intercourse
- Do not share use of personal items, such as towels or clothing
- Regularly screen for sexually transmitted infections if you have previously been diagnosed with LGV or are at risk of experiencing it