Lymphogranuloma Venereum (LGV)
Queensland Health Guidelines for Public Health Units
|1.0||December 2010||Full revision of guideline.|
|2.0||May 2015||Full revision of guideline.|
The agent is Chlamydia trachomatis serovars L1, L2 and L3.
Laboratory notification only. Laboratory reporting to Notifiable Conditions System.
Queensland Notification Criteria see: http://www.health.qld.gov.au/cdcg/documents/notif-criteria-guide.pdf
For case definitions see http://www.health.gov.au/internet/main/publishing.nsf/Content/cdna-casedefinitions.htm
Lymphogranuloma venereum (LGV) occurs worldwide, especially in tropical and subtropical areas. LGV is endemic in parts of Africa, India, Southeast Asia, South America and the Caribbean. It is hyperendemic among men who have sex with men (MSM) in parts of Europe and the United States. In Australia, LGV is a rare condition but an increase has been seen in MSM, with a high rate of co-infection with other sexually transmissible infections (STIs), hepatitis C virus (HCV), and/or HIV. In Australia, LGV is very uncommon in women. In the United Kingdom, LGV outbreaks have been associated with MSM often involved in dense sexual networks and/or with the sex party scene. The ulcerous character of LGV favours transmission and acquisition of HIV, blood borne viruses and other STIs.
In Australia, LGV is usually symptomatic and presentation with proctitis is common. Due to the high rate of co-infections tests for a full range of STIs should be conducted. Contact tracing is of high priority and due to the international distribution of sexual contacts, healthcare providers should have a heightened awareness for this condition, particularly in MSM.
The duration of potential infectivity is weeks to months, possibly years. Studies have shown that LGV DNA can persist in the rectum for up to 16 days after initiation of treatment and a long course of treatment and follow up is required.
Contact tracing for LGV is a high priority and should be performed in all patients with confirmed infection. Contact tracing can be conducted by the index case, the treating service provider, a referral agency (following consent by the index case), or a combination of these. For further information and assistance with STI contact tracing go to www.health.qld.gov.au and search 'contact tracing'.
Male and female partners should be traced back for a minimum of one month prior to the development of primary symptoms, or since arrival from an LGV endemic area if the infection is likely to have been acquired overseas. If asymptomatic, contact tracing for sexual partners in the last six months is recommended.
General promotion of safer sex practices, including the consistent use of condoms with all sexual partners and for sex toy use. Provision of education and counselling regarding STIs and negotiating safer sex should be given where appropriate.
Avoidance of any sexual contact when anogenital symptoms are present and for 21 days whilst taking treatment for a confirmed infection.
Find contact details for Queensland Health Sexual Health Services
Australasian Society for HIV Medicine, 2010. Australasian Contact Tracing Manual (4th ed).
Australasian Society for HIV Medicine, 2014. Australian STI Management Guidelines for use in Primary Care. http://www.sti.guidelines.org.au/ Accessed 14 October 2014.
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Holmes KK et al, 2008. Sexually Transmitted Diseases (4th ed). McGraw, New York.
International Union Against Sexually Transmitted Infections, 2013. European Guideline of the Management of Lymphogranuloma Venereum. http://www.iusti.org/regions/Europe/pdf/2013/LGV_IUSTI_guideline_2013.pdf Accessed 12 January 2015.
McMillan A. and Scott, G.R. 2000. Sexually Transmitted Infections (2nd ed.).
Simms I et al, 2006. Lymphogranuloma Venereum in Australia. Sexual Health, 3(3): 131–133.
White J, O'Farrell N, and Daniels D, 2013. 2013 UK National Guideline for the management of lymphogranuloma venereum. International Journal of STD & AIDS, 24(8), 593-601. http://www.bashh.org/documents/2013%20LGV%20guideline.pdf Accessed 12 January 2015.