Causes

  • Chlamydia trachomatis serovars L1, L2, and L3.
  • The L2 serovar has predominated among LGV cases in MSM.
  • In Australia, LGV primarily affects men who have sex with men (MSM) and most commonly presents as rectal infection (proctitis). 

Clinical presentation

  • LGV is commonly symptomatic and causes symptoms consistent with proctitis: U anorectal pain, discharge, tenesmus, bleeding and constipation. In some cases, symptoms can mimic nflammatory bowel disease.

  • Asymptomatic cases of rectal LGV can also occur.

  • Uncommonly, LGV can present as a primary ulcerative genital lesion and can lead to secondary inguinal buboes (painful suppurative inguinal abscess formation). 

  • For MSM who present with symptoms of proctitis, refer to the proctitis treatment guidelines. 

  • MSM who have a positive anal chlamydia test should be tested for LGV serotypes.  Some laboratories will do this automatically as a reflex add-on test.  

  • Men who arere asymptomatic contacts of LGV should be screened for chlamydia with urine and an anal swab. 

LGV ulcer
Penile acute LGV ulcer
1/2LGV ulcer

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LGV ulcers

Diagnosis

Test Site/ Specimen Comments
NAAT for Chlamydia Rectal Swab
Swab from ulcer
Aspirated fluid from inguinal buboes		 The LGV serovars can specifically be identified through genotyping of the chlamydia positive sample; however, not all laboratories are able to perform genotyping and may send the sample to a reference lab. 

Management

Index patient

Condition Recommended Extra comments
Suspected or confirmed LGV Doxycycline 100mg PO, twice daily for 21 days (first line)
OR
Azithromycin 1g PO, once per week for 3 doses. (second line)

Doxycycline is preferred over azithromycin as clinical data are lacking for azithromycin.

MSM who present with symptomatic proctitis that is positive for rectal C. trachomatis should be treated presumptively for LGV, irrespective of the LGV genotype result which may not be available for several days.

Inguinal buboes may require drainage  if not responding to antibiotics. This should be discussed with a sexual health or ID physician. 

Contact tracing & partner management

Contact tracing for LGV should be initiated.
All asymptomatic sexual partners of men with LGV should be screened for LGV and offered treatment with Doxycycline 100mg orally twice daily for 21 days.

Patients with LGV should avoid sex until treatment is completed and symptoms have fully resolved. 

Disclaimer

We recognise that gender identity is fluid. In our treatment guidelines, the words and language we use to describe genitals and gender are based on the sex assigned at birth.

The content of these treatment guidelines is for information purposes only. The treatment guidelines are generic in character and should be applied to individuals only as deemed appropriate by the treating practitioner on a case by case basis. Alfred Health, through MSHC, does not accept liability to any person for the information or advice (or the use of such information or advice) which is provided through these treatment guidelines. 

The information contained within these treatment guidelines is provided on the basis that all persons accessing the treatment guidelines undertake responsibility for assessing the relevance and accuracy of the content and its suitability for a particular patient. Responsible use of these guidelines requires that the prescriber is familiar with contraindications and precautions relevant to the various pharmaceutical agents recommended herein.