LGV, which is one of the four “classic” venereal diseases, has been a problem in countries in Africa, Asia, and Latin America in recent decades. For the past decade or so, increased cases have been recorded in major European cities. Since the disease is rather little known even among physicians, a rather high number of undetected infections must be assumed.
Of microbes and humans
LGV is caused by a particular type of the genus Chlamydia, spherical bacteria that are very common worldwide, multiply only within host cells, and can lead to a variety of clinical pictures. One of its three species important to humans is Chlamydia trachomatis, which with its serotypes D-K, causes sexually transmitted infections of the urinary tract and genital organs, as well as the most common cause of blindness worldwide, trachoma. In contrast, serotypes L1-L3 are responsible for the much rarer lymphogranuloma venereum. In contrast to the other types, these germs tend to spread throughout the entire body and thus also cause a so-called systemic infection. Transmission occurs during sexual intercourse, in Europe predominantly during unprotected anal intercourse. Homosexual men are therefore mostly affected. It is not uncommon for patients to have other STDs at the same time, such as syphilis and gonorrhea. Exact disease figures cannot be obtained even from the WHO because of the difficult laboratory diagnostics and the often unrecognized symptoms.
Symptoms and stages
The name already describes part of the course of the disease: lymphadenitis in the lymphatic drainage area of the reproductive organs. But this is only one stage of the total of three stages:
- Primary stage: at the entry point of the germ, e.g. in the vagina, on the glans and foreskin, rectum or urethra, small blisters or nodules form after about 3 weeks, which turn into an ulcer and heal again. Since this does not hurt, it is often not noticed. Inflammation of the urethra, cervix and rectum may occur.
- Secondary stage: about 6 weeks after infection, the lymph nodes near the initial infection (usually in a groin) swell painfully (“bubo”) and the overlying skin turns blue-red. The lymph nodes become larger and begin to ulcerate. In one third of those affected, the ulcers break outward. This is often accompanied by general symptoms such as fever, nausea, headache and pain in the limbs. Rarely, inflammation of the meninges, liver, joints or pericardium may also occur. If the pathogen was transmitted anally, there may be a painful rectal inflammation with bloody diarrhea.
- Tertiary stage: If left untreated, a symptom-free period of several years follows, during which, however, the pathogens continue to spread. They then cause chronic inflammation especially in the genital organs. These have fistulas, abscesses, obstruction of the rectum and lymphatic vessels with lymphatic congestion and partly massive swelling of the genitals and inflammation of the anus and urethra with severe pain during defecation and urination to result (“anogenitorectal syndrome”).
Detection and therapy
Laboratory diagnosis is difficult. It is made by cell culture of smears from the urethra, rectum, cervix or a lymph node. If chlamydia are detected, the type present must be determined. Unfortunately, it is not always possible to distinguish between the different types. Treatment is with doxycycline, an antibiotic, usually taken as a tablet for 3 weeks. Sexual partners with contact within the last two months before the onset of symptoms should be examined and treated if necessary. In some cases, the inflamed lymph nodes must be opened and extensive tissue destruction later corrected surgically. Sexual contact should not occur until treatment is completed and ulcers are completely healed.
To the point
- The LGV is v.a. a disease occurring in the tropics and subtropics, which is currently also increasingly occurring in Europe.
- Infection occurs through all sexual practices associated with mucosal contact, in Europe v.a. anal intercourse.
- Protection offer condoms.
- A complete cure by means of antibiotics is possible, otherwise there may be severe complications years later.
- The sexual partners should be treated if necessary.
