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Chapter 20



Lymphogranuloma venereum (LGV) is a venereal disease especially common in the tropics among black females of the lower socioeconomic groups with poor sexual hygiene. It must be considered in the differential diagnosis of any inflammatory process or stricture of the distal colon, especially the rectosigmoid area. Many a sailor or tourist, out for a night on the town in one of the seaports in the tropics, has acquired more than he bargained for from one of the "ladies of the evening," who in all probability had already distributed her "gift" to the local male population.

LGV has been confused since ancient times with other sexually transmitted diseases, especially syphilis and chancroid. It was first described by John Hunter in 1786, but over a century elapsed before Durand, Nicolas and Favre recognized it in 1913 as a distinct clinical and pathological infection. In 1922, Phylactos established that climatic bubo and LGV had a common cause; in 1925, Frei developed the skin test for LGV. Cultivation of the etiologic agent, Chlamydia trachomatis, in embryonated eggs occurred in 1935, paving the way for development of standardized antigen for the Frei skin test and for serodiagnosis.

Today, acute LGV is reported much more often in men than women, with a ratio of at least 5:1, and with a peak incidence in the third decade. It is most common in homosexual men presenting with proctitis. However, late complications such as ulceration and hypertrophy of genitalia and rectal strictures are seen more frequently in women because the infection is usually asymptomatic in its early stages in women, resulting in delayed diagnosis and treatment.


Lymphopathia venereum. Lymphogranuloma inguinale. Climatic, tropical or venereal bubo. Esthiomene. Inguinal poradenitis. Poradenolymphitis. Frei's disease. Durand-Nicolas-Favre disease. Sp: Linfogranuloma venereo. Bubo climatico. Fr: Lymphogranulomatose inguinale subaigue. Quatrieme maladie venerienne. Ger: Durand-Nicolas-Favre krankheit. Klimatischer bubo. Venerisches lymphogranuloma.


Lymphogranuloma venereum is a sexually transmitted infection caused by serotypes L-1, L-2 or L-3 of Chlamydia trachomatis, a minute, obligate intracellular, gram-negative bacillus. LGV is conveniently divided into 3 stages, with each stage having distinct clinical and pathological features.

Geographic Distribution

Lymphogranuloma venereum is widespread throughout the tropical and temperate regions of the world. The disease has been reported in all races and in most countries. It is particularly common among blacks of both sexes, but especially females. There is a high occupational risk for prostitutes, sodomists, and other sexually promiscuous persons. It is most common in seaports, especially in West and East Africa, South India, Southeast Asia, Indonesia, New Guinea, Australia, the southern United States (e.g., New Orleans), Jamaica and other islands of the Caribbean, and coastal cities of Latin America. In some areas it reaches epidemic proportions and constitutes an important public health problem. In Ethiopia there are reports of several thousand infections annually from a single urban clinic. By contrast, no European country has reported more than several dozen cases per year since 1950; in the United States less than 600 infections are reported annually, principally in homosexual men with proctitis.

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Copyright: Palmer and Reeder