LGV

WHAT IS LGV?

LGV (Lymphogranuloma venereum) is a sexually transmitted disease (STD) caused by three strains of the bacterium Chlamydia trachomatis. The visual signs include genital papule(s) (e.g., raised surface or bumps) and or ulcers, and swelling of the lymph glands in the genital area. LGV may also produce rectal ulcers, bleeding, pain, and discharge, especially among those who practice receptive anal intercourse. Genital lesions caused by LGV can be mistaken for other ulcerative STDs such as syphilis, genital herpes, and chancroid. Complications of untreated LGV may include enlargement and ulcerations of the external genitalia and lymphatic obstruction, which may lead to elephantiasis of the genitalia.

HOW COMMON IS LGV?

Signs and symptoms associated with rectal infection can be mistakenly thought to be caused by ulcerative colitis. While the frequency of LGV infection is thought to be rare in industrialized countries, its identification is not always obvious, so the number of cases of LGV in the United States is unknown. However, outbreaks in the Netherlands and other European countries among men who have sex with men (MSM) have raised concerns about cases of LGV in the U.S.

HOW DO PEOPLE GET LGV?

LGV is passed from person to person through direct contact with lesions, ulcers or other area where the bacteria is located. Transmission of the organism occurs during sexual penetration (vaginal, oral, or anal) and may also occur via skin to skin contact. The likelihood of LGV infection following an exposure is unknown, but it is considered less infectious than some other STDs. A person who has had sexual contact with a LGV-infected partner within 60 days of symptom onset should be examined, tested for urethral or cervical chlamydial infection, and treated with doxycycline, twice daily for 7 days.

WHAT ARE THE SIGNS AND SYMPTOMS?

LGV can be difficult to diagnose. Typically, the primary lesion produced by LGV is a small genital or rectal lesion, which can ulcerate at the site of transmission after an incubation period of 3-30 days. These ulcers may remain undetected within the urethra, vagina, or rectum. As with other STDs that cause ulcers, LGV may facilitate transmission and acquisition of HIV.

HOW IS LGV DIAGNOSED?

Because of limitations in a commercially available test, diagnosis is primarily based on clinical findings. Direct identification of the bacteria from a lesion or site of the infection may be possible through testing for chlamydia but, this would not indicate if the chlamydia infection is LGV. However, the usual chlamydia tests that are available have not been FDA approved for testing rectal specimens. In a patient with rectal signs or symptoms suspicious for LGV, a health care provider can collect a specimen and send the sample to his/her state health department for referral to CDC, which is working with state and local health departments to test specimens and validate diagnostic methods for LGV.

WHAT IS THE TREATMENT FOR LGV?

There is no vaccine against the bacteria. LGV can be treated with three weeks of antibiotics. CDC STD Treatment Guidelines recommend the use of doxycyline, twice a day for 21 days. An alternative treatment is erythromycin base or azithromycin. The health care provider will determine which is best.
If you have been treated for LGV, you should notify any sex partners you had sex with within 60 days of the symptom onset so they can be evaluated and treated. This will reduce the risk that your partners will develop symptoms and/or serious complications of LGV. It will reduce your risk of becoming re-infected as well as reduce the risk of ongoing transmission in the community. You and all of your sex partners should avoid sex until you have completed treatment for the infection and your symptoms and your partners’ symptoms have disappeared.
Note: Doxycycline is not recommended for use in pregnant women. Pregnant and lactating women should be treated with erythromycin. Azythromycin may prove useful for treatment of LGV in pregnancy, but no published data are available regarding its safety and efficacy. A health care provider (like a doctor or nurse) can discuss treatment options with patients.
Persons with both LGV and HIV infection should receive the same LGV treatment as those who are HIV-negative. Prolonged therapy may be required, and delay in resolution of symptoms may occur among persons with HIV.

HOW CAN LGV BE PREVENTED?

The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is asymptomatic and uninfected.
Male latex condoms, when used consistently and correctly, may reduce the risk of LGV transmission. Genital ulcer diseases can occur in male or female genital areas that may or may not be covered (protected by the condom).
Having had LGV and completing treatment does not prevent re-infection. Effective treatment is available and it is important that persons suspected of having LGV be treated as if they have it. Persons who are treated for LGV treatment should abstain from sexual contact until the infection is cleared.

Chlamydia

WHAT IS CHLAMYDIA?

Chlamydia is a common sexually transmitted disease (STD) caused by the bacterium, Chlamydia trachomatis, which can damage a woman's reproductive organs. Even though symptoms of chlamydia are usually mild or absent, serious complications that cause irreversible damage, including infertility, can occur "silently" before a woman ever recognizes a problem. Chlamydia also can cause discharge from the penis of an infected man.

HOW COMMON IS CHLAMYDIA?

Chlamydia is the most frequently reported bacterial sexually transmitted disease in the United States. In 2006, 1,030,911 chlamydial infections were reported to CDC from 50 states and the District of Columbia. Under-reporting is substantial because most people with chlamydia are not aware of their infections and do not seek testing. Also, testing is not often done if patients are treated for their symptoms. An estimated 2,291,000 non-institutionalized U.S. civilians ages 14-39 are infected with Chlamydia based on the U.S. National Health and Nutrition Examination Survey. Women are frequently re-infected if their sex partners are not treated.

HOW DO PEOPLE GET CHLAMYDIA?

Chlamydia can be transmitted during vaginal, anal, or oral sex. Chlamydia can also be passed from an infected mother to her baby during vaginal childbirth.
Any sexually active person can be infected with chlamydia. The greater the number of sex partners, the greater the risk of infection. Because the cervix (opening to the uterus) of teenage girls and young women is not fully matured and is probably more susceptible to infection, they are at particularly high risk for infection if sexually active. Since chlamydia can be transmitted by oral or anal sex, men who have sex with men are also at risk for chlamydial infection.

WHAT ARE THE SYMPTOMS OF CHLAMYDIA?

Chlamydia is known as a "silent" disease because about three quarters of infected women and about half of infected men have no symptoms. If symptoms do occur, they usually appear within 1 to 3 weeks after exposure.
In women, the bacteria initially infect the cervix and the urethra (urine canal). Women who have symptoms might have an abnormal vaginal discharge or a burning sensation when urinating. When the infection spreads from the cervix to the fallopian tubes (tubes that carry fertilized eggs from the ovaries to the uterus), some women still have no signs or symptoms; others have lower abdominal pain, low back pain, nausea, fever, pain during intercourse, or bleeding between menstrual periods. Chlamydial infection of the cervix can spread to the rectum.
Men with signs or symptoms might have a discharge from their penis or a burning sensation when urinating. Men might also have burning and itching around the opening of the penis. Pain and swelling in the testicles are uncommon.
Men or women who have receptive anal intercourse may acquire chlamydial infection in the rectum, which can cause rectal pain, discharge, or bleeding. Chlamydia can also be found in the throats of women and men having oral sex with an infected partner.

WHAT COMPLICATIONS CAN RESULT FROM UNTREATED CHLAMYDIA?

If untreated, chlamydial infections can progress to serious reproductive and other health problems with both short-term and long-term consequences. Like the disease itself, the damage that chlamydia causes is often "silent."
In women, untreated infection can spread into the uterus or fallopian tubes and cause pelvic inflammatory disease (PID). This happens in up to 40 percent of women with untreated chlamydia. PID can cause permanent damage to the fallopian tubes, uterus, and surrounding tissues. The damage can lead to chronic pelvic pain, infertility, and potentially fatal ectopic pregnancy (pregnancy outside the uterus). Women infected with chlamydia are up to five times more likely to become infected with HIV, if exposed.
To help prevent the serious consequences of chlamydia, screening at least annually for chlamydia is recommended for all sexually active women age 25 years and younger. An annual screening test also is recommended for older women with risk factors for chlamydia (a new sex partner or multiple sex partners). All pregnant women should have a screening test for chlamydia.
Complications among men are rare. Infection sometimes spreads to the epididymis (the tube that carries sperm from the testis), causing pain, fever, and, rarely, sterility.
Rarely, genital chlamydial infection can cause arthritis that can be accompanied by skin lesions and inflammation of the eye and urethra (Reiter's syndrome).

HOW DOES CHLAMYDIA AFFECT A PREGNANT WOMAN AND HER BABY?

In pregnant women, there is some evidence that untreated chlamydial infections can lead to premature delivery. Babies who are born to infected mothers can get chlamydial infections in their eyes and respiratory tracts. Chlamydia is a leading cause of early infant pneumonia and conjunctivitis (pink eye) in newborns.

HOW IS CHLAMYDIA DIAGNOSED?

There are laboratory tests to diagnose chlamydia. Some can be performed on urine, other tests require that a specimen be collected from a site such as the penis or cervix.

WHAT IS THE TREATMENT FOR CHLAMYDIA?

Chlamydia can be easily treated and cured with antibiotics. A single dose of azithromycin or a week of doxycycline (twice daily) are the most commonly used treatments. HIV-positive persons with chlamydia should receive the same treatment as those who are HIV negative.
All sex partners should be evaluated, tested, and treated. Persons with chlamydia should abstain from sexual intercourse until they and their sex partners have completed treatment, otherwise re-infection is possible.
Women whose sex partners have not been appropriately treated are at high risk for re-infection. Having multiple infections increases a woman's risk of serious reproductive health complications, including infertility. Retesting should be encouraged for women three to four months after treatment. This is especially true if a woman does not know if her sex partner received treatment.

HOW CAN CHLAMYDIA BE PREVENTED?

The surest way to avoid transmission of STDs is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
Latex male condoms, when used consistently and correctly, can reduce the risk of transmission of chlamydia.
CDC recommends yearly chlamydia testing of all sexually active women age 25 or younger, older women with risk factors for chlamydial infections (those who have a new sex partner or multiple sex partners), and all pregnant women. An appropriate sexual risk assessment by a health care provider should always be conducted and may indicate more frequent screening for some women.
Any genital symptoms such as an unusual sore, discharge with odor, burning during urination, or bleeding between menstrual cycles could mean an STD infection. If a woman has any of these symptoms, she should stop having sex and consult a health care provider immediately. Treating STDs early can prevent PID. Women who are told they have an STD and are treated for it should notify all of their recent sex partners (sex partners within the preceding 60 days) so they can see a health care provider and be evaluated for STDs. Sexual activity should not resume until all sex partners have been examined and, if necessary, treated.