L1, L2, and L3 genovars/serovars of Chlamydia trachomatis are endemic to tropical regions of Southeast Asia, Latin America, the Caribbean and Africa. Historically, LGV has been considered a rare disease in developed countries of temperate climates; however, in urban areas of Europe and North America, outbreaks of LGV proctocolitis have been reported among men who have sex with men (MSM), often in association with transmission of syphilis, HIV, and hepatitis C.[9]Centers for Disease Control and Prevention. Lymphogranuloma venereum among men who have sex with men - Netherlands, 2003-2004. MMWR Morb Mortal Wkly Rep. 2004 Oct 29;53(42):985-8.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5342a2.htm
http://www.ncbi.nlm.nih.gov/pubmed/15514580?tool=bestpractice.com
[10]de Voux A, Kent JB, Macomber K, et al. Notes from the field: cluster of lymphogranuloma venereum cases among men who have sex with men - Michigan, August 2015-April 2016. MMWR Morb Mortal Wkly Rep. 2016 Sep 2;65(34):920-1.
https://www.cdc.gov/mmwr/volumes/65/wr/mm6534a6.htm
http://www.ncbi.nlm.nih.gov/pubmed/27583686?tool=bestpractice.com
LGV occurs rarely in the US but as it is not a notifiable STI, current incidence rates are difficult to ascertain.
LGV may occur at any age, but the peak incidence is between 15 and 40 years, the ages when sexual activity is at its peak.[11]Ceovic R, Gulin SJ. Lymphogranuloma venereum: diagnostic and treatment challenges. Infect Drug Resist. 2015;8:39-47.
https://www.doi.org/10.2147/IDR.S57540
http://www.ncbi.nlm.nih.gov/pubmed/25870512?tool=bestpractice.com
LGV is more commonly reported in men because early signs are more apparent in men, but it is thought that men and women are probably equally affected.[11]Ceovic R, Gulin SJ. Lymphogranuloma venereum: diagnostic and treatment challenges. Infect Drug Resist. 2015;8:39-47.
https://www.doi.org/10.2147/IDR.S57540
http://www.ncbi.nlm.nih.gov/pubmed/25870512?tool=bestpractice.com
Studies among MSM who reported receptive anal intercourse in Germany, the UK, and Netherlands have shown that LGV may be asymptomatic in about one quarter of cases.[12]de Vrieze NH, van Rooijen M, van der Loeff MF, et al. Anorectal and inguinal lymphogranuloma venereum among men who have sex with men in Amsterdam, the Netherlands: trends over time, symptomatology and concurrent infections. Sex Transm Infect. 2013 Nov;89(7):548-52.
http://www.ncbi.nlm.nih.gov/pubmed/23427272?tool=bestpractice.com
[13]Saxon C, Hughes G, Ison C. Asymptomatic lymphogranuloma venereum in men who have sex with men, United Kingdom. Emerg Infect Dis. 2016 Jan;22(1):112-6.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4696683
http://www.ncbi.nlm.nih.gov/pubmed/26691688?tool=bestpractice.com
Reporting from endemic regions suggest that LGV is less common than herpes simplex virus or syphilis as a predominant cause of genital ulcer disease, and less common than chancroid as a cause of inguinal lymphadenopathy.[14]Viravan C, Dance DA, Ariyarit C, et al. A prospective clinical and bacteriologic study of inguinal buboes in Thai men. Clin Infect Dis. 1996 Feb;22(2):233-9.
http://www.ncbi.nlm.nih.gov/pubmed/8838178?tool=bestpractice.com
[15]Brathwaite AR, Figueroa JP, Ward E. A comparison of prevalence rates of genital ulcers among persons attending a sexually transmitted disease clinic in Jamaica. West Indian Med J. 1997 Sep;46(3):67-71.
http://www.ncbi.nlm.nih.gov/pubmed/9361493?tool=bestpractice.com
[16]Behets FM, Andriamiadana J, Randrianasolo D, et al. Chancroid, primary syphilis, genital herpes, and lymphogranuloma venereum in Antananarivo, Madagascar. J Infect Dis. 1999 Oct;180(4):1382-5.
https://academic.oup.com/jid/article/180/4/1382/846878
http://www.ncbi.nlm.nih.gov/pubmed/10479178?tool=bestpractice.com