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Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by a more aggressive strain of the bacterium Chlamydia trachomatis. While it’s a type of chlamydia, LGV is more invasive — it spreads beyond the surface of the genitals and can infect the lymph nodes and rectum, causing painful and serious symptoms.
LGV is most common among men who have sex with men (MSM), particularly those who are HIV-positive or have multiple sexual partners. It’s relatively rare in the U.S. overall, but cases are rising in some urban sexual health networks. LGV is often misdiagnosed as other conditions like inflammatory bowel disease (IBD), herpes, or syphilis.
Unlike typical chlamydia, LGV can cause severe inflammation, abscesses, and rectal bleeding. But with the right antibiotics, it’s fully treatable.
What Are Symptoms of LGV?
LGV symptoms typically develop in three stages, and the signs can vary based on how the infection entered the body — usually through the genitals, anus, or mouth.
Stage 1: Small painless sore
- A tiny ulcer or bump appears at the site of exposure — often the genitals, anus, or mouth
- This sore usually heals on its own, so it’s easy to miss
Stage 2: Painful swollen lymph nodes (inguinal syndrome)
- Occurs 2 to 6 weeks after exposure
- Swollen, tender lymph nodes in the groin (can become large and painful)
- Fever, chills, fatigue, muscle aches
- In some cases, abscesses or draining sores in the groin
Stage 2 (rectal form — proctitis):
More common in MSM, especially with receptive anal sex:
- Anal pain or pressure
- Rectal discharge (may be bloody)
- Pain with bowel movements
- Constipation or straining
- Mucus or pus from the rectum
Stage 3 (untreated cases):
- Chronic inflammation can lead to scarring, fistulas, or strictures
- Long-term complications affecting rectal or genital function
Symptoms can overlap with herpes, gonorrhea, hemorrhoids, or even Crohn’s disease — making LGV hard to identify without testing.
What Does LGV Look Like?
In early stages, LGV may look like a small, painless sore on the genitals or around the anus — very similar to syphilis or herpes. But what makes LGV unique is its deep tissue inflammation and lymph node swelling, especially in the groin or rectal area.
You may notice:
- Enlarged, tender lumps under the skin in your groin
- Open sores or draining abscesses
- Swelling or redness near the rectum
- Blood or mucus in your stool
These symptoms usually don’t appear with typical chlamydia and often signal that the infection has spread internally.
How Is LGV Transmitted?
LGV spreads through unprotected sexual contact involving the anus, vagina, or mouth. It’s caused by specific strains (L1, L2, L3) of Chlamydia trachomatis, which invade deeper tissue than regular chlamydia.
Common routes of transmission:
- Receptive anal sex (most common in MSM)
- Vaginal or oral sex
- Shared sex toys without proper cleaning
- Direct contact with sores or mucous membranes
LGV can be passed even if symptoms are mild or absent. People can carry the infection and still transmit it.
How Do You Test for LGV?
LGV is diagnosed with a chlamydia test, usually from a rectal swab or urine sample. If the result is positive, special lab testing (NAAT genotyping or molecular subtyping) is needed to confirm it’s the LGV strain.
What testing may involve:
- Rectal swab if you have symptoms of proctitis
- Urine test or swab of genital sores
- Blood tests to rule out other STIs (HIV, syphilis, herpes)
Not all clinics can distinguish LGV from regular chlamydia — so if you’re in a high-risk group, ask specifically about LGV testing.
How Is LGV Treated?
LGV is curable with antibiotics — but treatment must last longer than for standard chlamydia.
Recommended treatment:
- Doxycycline 100 mg twice a day for 21 days
- In severe cases, a provider may add pain relief or drainage of swollen lymph nodes
It’s important to complete the full course — even if symptoms improve earlier — to prevent long-term complications.
Sexual partners from the past 60 days should also be tested and treated to avoid reinfection and stop the chain of transmission.
Complications of LGV
Untreated LGV can lead to serious, long-term health problems:
- Chronic rectal inflammation (proctocolitis)
- Genital or anal scarring
- Abscesses or fistulas
- Rectal strictures that make bowel movements difficult
- Increased risk of HIV transmission and acquisition
Early diagnosis and full treatment reduce the risk of complications. Even if symptoms seem mild, LGV should be taken seriously.
Outlook & Prognosis
When treated properly, LGV clears up without permanent damage in most people. Symptoms usually improve within days of starting antibiotics, and full healing happens over several weeks.
The key is early recognition. Because LGV mimics other conditions — including hemorrhoids, IBS, or syphilis — it’s often overlooked. If you’re at risk or have unexplained anal or groin symptoms, ask for LGV testing specifically.
Living With LGV
Most people fully recover from LGV with treatment, but the experience can be painful and emotionally draining. The stigma around rectal symptoms and STIs — especially in MSM communities — can make it hard to talk about.
If you’re diagnosed with LGV:
- Take all antibiotics exactly as prescribed
- Avoid sex until your provider clears you
- Tell partners so they can get treated, too
- Consider a full STI panel, including HIV
Support is available. Clinics that serve LGBTQ+ communities often offer affirming care and resources tailored to your needs.
How to Tell Your Partner(s) You Have LGV
You don’t have to go into all the medical details. A simple, clear message works best:
“I was recently diagnosed with LGV — it’s a type of chlamydia that affects the lymph nodes or rectum. It’s treated with antibiotics, and I’m taking care of it now. You should consider getting tested too.”
Let them know:
- LGV is curable
- Many people don’t have symptoms but can still spread it
- You’re being proactive because you care about their health
These conversations can be uncomfortable, but they’re also responsible, mature, and necessary.
Last reviewed: May 2025
This content is regularly reviewed and updated to reflect the latest medical guidelines.
- Caused by: Bacteria (Chlamydia trachomatis, serovars L1, L2, L3)
- Spread through: Unprotected anal, vaginal, or oral sex; contact with infected mucous membranes or lesions
- Symptoms: Rectal pain, discharge, swollen lymph nodes, genital ulcers, or proctitis
- Testing: Rectal or genital swab with chlamydia NAAT; genotyping confirms LGV strain
- Treatment: 21-day course of doxycycline; treat partners from last 60 days
- Risk if untreated: Scarring, abscesses, fistulas, rectal strictures, increased HIV risk
- How common: Rare in general U.S. population; increasing among MSM in urban sexual health networks