History and exam
Key diagnostic factors
common
presence of risk factors
Risk factors include other STDs and unprotected intercourse in an area endemic for LGV.
inguinal lymphadenopathy
During the secondary stage, tender lymphadenopathy is the classic presentation. One third will have bilateral node involvement.[33]
uncommon
non-specific symptoms of proctocolitis
Symptoms such as anorectal pain, rectal bleeding or mucopurulent discharge, diarrhoea or constipation, abdominal cramping, reduced anorectal aperture, or tenesmus are non-specific symptoms of proctocolitis. Men who have sex with men at high risk for LGV with these symptoms should be screened.[21]
groove sign of Greenblatt
Twenty percent of affected men will have both femoral and inguinal node involvement. The groove is created by the inguinal ligament.[2]
genital elephantiasis, saxophone penis, esthiomene
Late stages may occur several years after initial infection. These findings are a result of progressive lymphangitis, chronic oedema, and sclerosing fibrosis of the subcutaneous tissues.[22]
Other diagnostic factors
common
fever, malaise, arthralgias
Non-specific symptoms that may accompany lymphatic spread indicating a systemic response to infection.
lower abdominal or lower back pain
Non-specific symptoms that may indicate deep iliac node involvement.[22]
uncommon
genital or anal ulcer
non-specific symptoms of bacteraemic spread
Arthritis, hepatitis, pericarditis, pneumonia, and meningo-encephalitis are all non-specific signs that may accompany bacteraemic spread, indicating a systemic response to infection.
erythema nodosum
Erythema nodosum is occasionally associated with LGV.[8]
anogenital sinus tracts, strictures, or fistulae
Sequelae of chronic infection may result in fibrosis and formation of sinus tracts and strictures of the anogenital tract as abscesses rupture.
Risk factors
strong
other STIs
Those at risk for other STIs are also at risk for LGV. Having concurrent gonorrhoeal proctitis and genital ulcerative disease, including anogenital herpes and syphilis, were also found to be strong independent risk factors.[21]
No recent studies clearly distinguish these risk factors or include patients other than men who have sex with men; however, the association with other STIs most likely is related to risky sexual behaviour.
risky sexual behaviour
Participating in risky sexual behaviour (including sex with anonymous or casual partners and unprotected intercourse) is a strong independent risk factor.[21]
HIV-seropositivity
No studies have shown that susceptibility to LGV is affected by immune status or prior HIV infection; however, the inflammatory or ulcerative nature of STIs may augment transmissibility and susceptibility to HIV.[22]
In a case-control study comprising solely of a group of men who have sex with men (MSM) following an outbreak of LGV in The Netherlands, HIV seropositivity was the strongest associated factor (when compared with a control group of MSM without anorectal chlamydia).[21]
In a meta-analysis of 13 studies from 2000 to 2009, the prevalence of HIV among LGV cases in the MSM population ranged from 67% to 100%. MSM with LGV were over 8 times more likely to have HIV than those who had non-LGV chlamydia infection.[23]
age (20 to 40 years)
Transmission most frequently occurs during ages of highest sexual activity.
Although LGV is not common at younger ages, infants may be infected by their mother during delivery and passage through the vaginal canal.[22]
weak
unprotected intercourse in an area endemic for LGV
Although recent studies of risk factors for LGV include only men who have sex with men in an outbreak setting, the same risk factors are likely relevant for heterosexual women and men, particularly those who live in or travel to an endemic area. LGV cases reported in non-endemic areas are typically travellers who visit endemic areas.[22]
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