LGV is a sexually transmitted infection (STI) caused by one of three invasive serovars (L1, L2 or L3) of Chlamydia trachomatis.
‘Classic’ LGV is a condition endemic in heterosexuals in areas of Africa, India, S.E. Asia and the Caribbean where it manifests as genital ulcer disease and lymphadenopathy (without proctitis).
LGV re-emerged in Europe in 2003 with subsequent outbreaks in major cities across the European area, the largest of which has been in the UK with 5302 diagnosis reported by the end of 2016. 99.7% were made in men. In Scotland, although there was an increase from an annual diagnosis of 11 from 2012 to 2015 to 45 during 2016, and 23 cases in 2017, transmission of this infection has not become well established in our MSM population. LGV infection is associated with high levels of concurrent STIs, in particular HIV, and high risk sexual behaviour including multiple anonymous partners.
Most patients in the European outbreak have presented with proctitis; symptoms included rectal pain, anorectal bleeding, mucoid and/or haemopurulent rectal discharge, tenesmus, diarrhoea or altered bowel habit and other symptoms of lower gastrointestinal inflammation. Some patients reported systemic symptoms such as fever and malaise. Asymptomatic infection can occur.
Genital ulcers and inguinal symptoms are less common; nonetheless ‘‘classical’’ LGV has been reported in MSM in the European outbreak and clinicians need to be alert for these presentations. Several cases of pharyngeal LGV have also been reported.