Lymphogranuloma venereum (LGV)

Lymphogranuloma venereum (LGV) is caused by Chlamydia trachomatis L1 to L3 serovars, and is endemic in Australia among gay, bisexual and other men who have sex with men, and transgender women. Most cases present with symptoms of proctitis (eg anorectal discharge, pain, bleeding). LGV can cause anal ulceration followed by strictures and fistulas, and may also cause genital ulceration followed by lymphadenopathyOng, 2023.

Request nucleic acid amplification testing (NAAT) (eg polymerase chain reaction [PCR]) for LGV for gay, bisexual and other men who have sex with men, and transgender women with anorectal symptoms and a positive NAAT for C. trachomatis on an anorectal swab.

If LGV is identified or cannot be excluded (eg testing is not available), useOng, 2023:

If doxycycline is contraindicated, seek specialist advice; limited data support the use of azithromycin2016Leeyaphan, 2017Leeyaphan, 2016.

Advise patients toOng, 2023:

• abstain from sexual contact for 21 days (ie until treatment is completed)
• notify partners from 3 months before symptom onset or 6 months before an asymptomatic diagnosis.

Full treatment courses with the regimen above are usually given to contacts even if microbiological tests do not identify LGV, because of the risk of serious complications. See also STI contact tracing.

Repeat NAAT for C. trachomatis 3 weeks after treatment completion to test for cureOng, 2023.