"Lymphogranuloma venereum (LGV) is caused by C. trachomatis serovars L1, L2, or L3. The most common clinical manifestation of LGV among heterosexuals is tender inguinal and/or femoral lymphadenopathy that is typically unilateral. A self-limited genital ulcer or papule sometimes occurs at the site of inoculation. However, by the time patients seek care, the lesions might have disappeared. Rectal exposure in women or MSM might result in proctocolitis (including mucoid and/or hemorrhagic rectal discharge, anal pain, constipation, fever, and/or tenesmus). LGV is an invasive, systemic infection, and if it is not treated early, LGV proctocolitis might lead to chronic, colorectal fistulas and strictures. Genital and colorectal LGV lesions might also develop secondary bacterial infection or might be coinfected with other sexually and nonsexually transmitted pathogens.

Diagnosis is based on clinical suspicion, epidemiologic information, and the exclusion of other etiologies (of procto-colitis, inguinal lymphadenopathy, or genital or rectal ulcers), along with C. trachomatis testing, if available. Genital and lymph node specimens (i.e., lesion swab or bubo aspirate) may be tested for C. trachomatis by culture, direct immunofluorescence, or nucleic acid detection. Nucleic acid amplification tests (NAAT) for C. trachomatis are not FDA-cleared for testing rectal specimens. Additional procedures (e.g., genotyping) are required for differentiating LGV from non-LGV C. trachomatis but are not widely available.

Chlamydia serology (complement fixation titers >1:64) can support the diagnosis in the appropriate clinical context. Comparative data between types of serologic tests are lacking, and the diagnostic utility of serologic methods other than complement fixation and some microimmunofluorescence procedures has not been established. Serologic test interpretation for LGV is not standardized, tests have not been validated for clinical proctitis presentations, and C. trachomatis serovar-specific serologic tests are not widely available.

In the absence of specific LGV diagnostic testing, patients with a clinical syndrome consistent with LGV, including proc-tocolitis or genital ulcer disease with lymphadenopathy, should be treated for LGV as described in this report"

Symptoms

The first symptom may be a small, painless pimple or lesion occurring on the penis or vagina. It is often unnoticed. The infection then spreads to the lymph nodes in the groin area and from there to the surrounding tissue. Complications may include inflamed and swollen lymph glands which may drain and bleed.The incidence is highest among sexually active people living usualy in tropical and subtropical area. It has also occurred in some areas of the southern United States.

*Painless genital ulcer

*Swollen Groin Lymph nodes

*Redness and inflammation on groin

*Pain while having bowel movement

*Pus or blood in stool

*Lymph node drainage

What is our main problem to diagnose LGV:

We were affiliated with major medical laboratory and were able to do serology blood test about 2 years ago ,however, medical lab discontinue offering the test. When we seek for answer we found out that apparently they did not have much of order so the test was not cost effective. We were disappointed and we are currently trying to see if we could find any other lab running that test if not then we have to look into bring that test to our own lab.

If we are not looking for LGV then it will continue to be under diagnosed in the US. As we do not have many case report of LGV in USA then we do not know if we are not simply looking for it beside the disease being uncommon. If that is the case then we have under report cases of LGV .

How LGV could be prevented:

The only way to prevent STDs is by not having sex at all. If you do have sex, you can

 lower your risk by only having sex with (1) someone who doesn't have an STD and

(2) isn't having sex with anyone else.

Proper use of Latex condom may decrease the risk of LGV transmission.

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