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College guy that just donated to the foundation. Lymphogranuloma Venereum (LGV, 2010)
Jun 4, 2010

Good evening Dr. Bob,

I am a heterosexual male in my mid 20's and now engaged. I have only been with 5 woman in my past. Prior to my engagement and meeting my fiance , I had a one time unprotected episode of oral and vaginal sex with a female. this was october of 2007.

4 weeks after I had a painless rash on the head of my penis under my urethral opening. then I became sick . low grade fever up to 100.9 , dry cough, conjunctivitis in both eyes, sore throat, and eventually generalized lymphadenopathy. The sore throat lasted a few months as well as the cough.

During the time of the rash I also developed painful ejaculation . I never noticed discharge. I tested negitive for chlamydia and Gon. by urinalysis howeer the doc said it was not very accurate and treated me with doxy for a 10 days. By the time I had the meds it was 7 weeks past this event.

my lymphnodes are present on both sides of my neck, behind my ear, and under my arms. They ache and sting on occasion and as you can see its been going on 3 years past this.

I have had 17 hiv test within the first year. then my 18th (oraquick advance) 2.3 years past this event. there have been no other encounters.

I want to stop thinking of HIV. however the series of events that led to this sickness and the rash on my penis that was present with painful ejaculation has inhibited this .

Also, at ten weeks past I had an undetectable Viral load for HIV also.

I started testing for a few other things like syphilis and herpes and all was negitive.

Recently,I spoke with a urologist who said this sounds like stage 2 or 3 of LGV. and A few doctors said yes my nodes were shotty but said forget about HIV. My virology professor at my university said it would be extremely rare at this point for HIV.

1) the urologist mentioned he thinks I have stage 2 or 3 LGV.... I live in ohio and this one episode was with a Caucasian female in her 20's ( I found out she had been with 20 males :( ). Wouldn't LGV be a very rare occurrence in ohio?

2.) I took a monospot the same time I did the viral load for HIV, the mono spot was negative along with the Viral load. I have recently spoke with someone that had 2 negativite mono spots tests but then had a positive PCR for Mono.... is the mono spot not very accurate? - are the oraquick HIV more accurate?

3.) Most medical books say detectable antibodies can take up to 36 months to develope. is this only for babies born to HIV positive mothers? or can this be for the general population also?

4) I am engaged to a beautiful woman now. I dont want HIV to come into our relationship. Is there any chance I could still be seroconverting? or after the symptoms cleared a few years ago would you definently test positive after the symptoms declined?

I will be donating again when I get more money however, I gave $20. I know thats not much but I want to donate as much as possiable at the given time.

Thank you Doctor Bob

Response from Dr. Frascino

Hi,

You had a one-time unprotected nookie in 2007. Since then you've had 18 negative HIV-antibody tests out to 2.3 years plus an undetectable quantitative HIV plasma RNA PCR viral load at 10 weeks. Exactly what part of "HIV negative" are you having difficulty comprehending? Dude, you just can't get any more negative than that! Your multiple negative HIV tests are definitive, conclusive, WOO-HOO-able, move-on-able and highly excessive. HIV is not your problem. No way. No how. No additional HIV-related tests are warranted. You've had far too many already.

I cannot in retrospect diagnose the cause of your post-nookie symptoms or your current "shotty nodes", but what I can do with absolute certainty is advise what's not causing them: It's not HIV!

Responding to your specific questions:

I, too, would tend to doubt a diagnosis of LGV. I'll print some information about that condition below.

Monospots are quite accurate. You don't have mono. Likewise HIV OraQuick tests are also quite accurate. You don't have HIV either.

Regarding HIV seroconversion, the vast majority of folks will develop detectable levels of anti-HIV antibodies in their blood within four to six weeks following HIV primary infection. HIV-antibody testing is generally considered reliable at the three-month mark. On rare occasions or with extenuating circumstances HIV seroconversion may take as long as six months.

Is there any chance you could still be seroconverting? No, absolutely not.

Your HIV fears are irrational and totally unwarranted. I would suggest you seek counseling (psychotherapy) to help you confront and conquer these fears. That they have persisted for three years suggest you'll need psychological help in overcoming them.

Thank you for your support of The Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's warmly appreciated.

Be well.

Dr. Bob

Lymphogranuloma Venereum (LGV) January 4, 2008

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 of LGV?

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.

Where Can I Get More Information?

Division of STD Prevention (DSTDP) Centers for Disease Control and Prevention

Personal Health Inquiries and Information About STDs

CDC-INFO 1-800-CDC-INFO (800-232-4636) TTY: 1-888-232-6348 In English, en Español

CDC National Prevention Information Network (NPIN) P.O. Box 6003 Rockville, MD 20849-6003 1-800-458-5231 1-888-282-7681 Fax 1-800-243-7012 TTY E-mail: info@cdcnpin.org

American Social Health Association (ASHA) P. O. Box 13827 Research Triangle Park, NC 27709-3827 1-800-783-9877

Clinical Resources

Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines 2006. MMWR 2006;55(no. RR-11).

Lymphogranuloma Venereum Among Men Who Have Sex with Men -- Netherlands, 2003-2004. MMWR, October 29, 2004

Perine, PL, Stann, WE. Lymphogranuloma venereum. In: K. Holmes, P. Sparling, P. Mardh et al (eds). Sexually Transmitted Diseases, 3rd edition. New York: McGraw-Hill, 1999, p. 423-432.

How common is this STD? Aug 1, 2008

Hello,

I read on here about lymphogranuloma venereum desease. I am curious how easy this is to get in America? I read you can catch it from oral, "I assume in giving oral or receiving". Not saying I got this, but in May or June I got a BJ and a few weeks later started having symptoms, most i know I caused in worry. But the symptoms sure were real, my tail bone seemed very bruised to sit down or get up and my feet and hands would tingle or fall asleep then be fine for a few days and it start again. Now that my tail bone has almost healed the feet/hands seem much better, also I had BMS with no visual problems in my mouth at all. I should mention I have a great deal of stress in my life so that is a factor I know, and if I drink a lot of coffee it flares up the BMS.Now that all that has settled down, for the past 5 weeks my lymphnodes in my groin constantly seem a tad bit swollen just enough to say "were here" sometimes just the left one or just the right one, not really painful just irritating. They feel semi-hard some what to the touch all the time but maybe thats just how they are for me. thanks for the help in advance. BTW, I point everyone to this site.

Response from Dr. Frascino

Hello,

Your symptoms are not consistent with lymphogranuloma venereum (LGV). I'll reprint some information from the archives that addresses your concerns about LGV. I should also point out your symptoms are very consistent with stress!

Dr. Bob

LGV testing Feb 7, 2007

Hi Dr Bob,

I don't know if you are familiar with this rare std.. Lymphomgranuloma Venereum or LGV. It seems to have similar symptoms of HIV.. I tested negative for HIV out to 6mos and have tested negative for other stds as weel. Can LGV be picked up by the standard chlamydia test being that it is a form of chlamydia?

Thank you

Response from Dr. Frascino

Hello,

Yes, I'm familiar with rare STDs, including LGV. (After all, I am the cyber sexpert around here, right?) I'll repost some information from the archives that addresses this topic.

Dr. Bob

Lymphogranuloma Venereum (LGV)

June 19, 2006

Lymphogranuloma venereum (LGV) is a systemic, sexually transmitted disease (STD) caused by a type of Chlamydia trachomatis (serovars L1, L2, or L3) that rarely occurs in the United States and other industrialized countries. However, The Netherlands (MMWR Oct. 29, 2004) and other European countries have reported increases in LGV proctitis among men who have sex with men (MSM). The MMWR article describes The Netherlands' LGV finding including clinical signs and symptoms along with CDC's 2002 STD Treatment Guidelines for LGV. Using LGV testing technology not commercially available (LGV genotyping), CDC has assisted state and local health departments in identifying patients with LGV in cities across the United States. The majority of patients with LGV proctitis in the U.S. have been HIV-infected MSM. In states that lack laboratory capacity to perform LGV diagnostic testing, specimens may be submitted to CDC's Chlamydia Laboratory for testing. If you are a clinician with patients with symptoms consistent with LGV [mucoid/purulent anal discharge, rectal bleeding, constipation, inguinal/femoral lymphadenopathy (buboes), genital or rectal ulcer or papule, anal spasms, and/or tenesmus], please contact your state or local health departments. If state or local testing for LGV proctitis is unavailable, the state public health laboratory may forward specimens to CDC for testing.

At CDC, specimens will be tested for C. trachomatis and, if positive, will be genotyped for the identification of LGV. Serology will only be performed in conjunction with specimens tested directly for LGV (e.g. rectal swabs).

If you have patients you suspect of having LGV, or have questions about LGV, please contact both your state and local health departments. Thank you in advance for your efforts to assist in the prompt identification and control of LGV in the United States.

If you have additional questions about CDC activities regarding LGV, please contact cdclgvinfo@cdc.gov.

LGV (lymphogranuloma venereum) Please answer May 4, 2005

Hi Doctor,

While reading the archive, I came across a post about LGV (lymphogranuloma venereum). The post is located at URL http://www.thebody.com/Forums/AIDS/SafeSex/Current/Q163965.html

titled and dated respectively Experiencing symptoms? Read This! , Posted: Mar 27, 2005.

Briefly, in that post a lady is telling a story about her husband who got lymphogranuloma venereum during an intercourse with a sex worker when the condom broke. She stated that she and her husband had a protected intercourse (using a condom) quote Then had sex with me using a condom, (no breaks) thinking he was being overly cautious protecting me from any possible STD's End Quote.

Now, in spite of that fact She and her husband had a protected sex, she got the lymphogranuloma venereum.

My question is could the lymphogranuloma venereum penetrate the latex unbroken condoms?

Thank You.

Response from Dr. Frascino

Hi,

Latex condoms are impermeable to particles the size of STD germs, including Lymphogranuloma venereum, a rare type of Chlamydia. That we know from laboratory studies. What we do not know is whether the questioner you quoted used a latex condom properly or not.

Hope that helps.

Dr. Bob

Experiencing symptoms? Read This! Mar 27, 2005

Dr. Bob,

I just want to share my story so that others who think they might be experiencing ARS symptoms get immediate medical attention because there is a rare STD out there making the rounds that has very similar symptoms to ARS and serious complications if left untreated.

I am a married, white, upper middle class surburban mom who has not had a new sexual partner for more than 20 years. My husband recently traveled to Tashkent Uzbekistan on business. and while drunk, had normal vaginal sex with a female sex worker.(The jerk!) Unfortunately, the condom he used broke and he was exposed. He visited a Dr. four days after exposure and tested negative for all common STD's Then had sex with me using a condom, (no breaks) thinking he was being overly cautious protecting me from any possible STD's. In the mean time, within the first week of exposure he started experiencing a vague sort of pain in his penis and at 4 weeks, he experienced full blown flu like symptoms. Low grade fever, severe headache, general malaize, joint pain and body aches, exhaustion, every single ARS symptom except night sweats. The vague discomfort in his penis spread to the testicles and even into his lower abdomen. Then he experienced a rash on his Chest. He was positively positive that he was experiencing ARS symptoms and was devastated by his stupid drunken mistake. In the meantime, I began experiencing all the same symptoms minus the rash. I was even starting to believe we both might have HIV. But my exposure was with a condom; my doctor didn't think I could possibly have anything.And Dr. Bob, you've always assured people that HIV does not travel through an intact condom! My husband visited many doctors, they would prescribe a week of Doxycycline, then a penicillan shot, then Z-pacs. He was on Cipro for a month! Nothing helped! I went to the gynocologist within two weeks of sex with my husband and tested negative for all STD's. I still was feeling poorly and had a slight swelling in the groin area. The doctor commented on it but said "I'm not worried about that." I went to the doctor 4 times over the next 4 months and they thought I was crazy! They humored me and retested for everything again except for Clamydia thinking it deffinently would have shown up in the first test. Negative on everything. My husband and I were miserable because something was deffinently wrong and getting worse! Finally HIV tests for both of us confirmed we DID NOT have HIV. But nobody knew what was wrong with us. Finally my husband went to a urologist and lo and behold, somebody who could put a name to it! LGV. His urologist had just received an e-mail from the CDC about it making a comeback to the US. If you look on the internet, It implies that it is an STD only for Gay men having anal sex. Well I'm here to tell you, neither my husband or I have EVER had anal sex and we were not affected anally by it but we contracted it nevertheless and when I went back to my doctor and told him to specifically test my titer for Chlamydia, sure enough, it was what I was infected with. My husband and I had been living with LGV and are still fighting it for four months now. All the drugs he originally took lowered his Chlamydia titer but never completely got rid of it. and I guess I was tested too early or maybe they simply should have used the more sensitive test but I just want everyone to know out there that this is a serious, nasty, particularly hard to diagnose and get rid of strain of Chlamydia. My husband and I are on massive amounts of Erythromycin now. The daily dosage is so high that it causes us to vomit and we are still fighting to get rid of it because we did not catch it quickly. My doctor was completely embarrased by not being able to diagnose it and by making me feel like I was a hypocondriac. If your experiencing symptoms, just mention LGV to your doctor. Most Doctors in surburban areas have rarely seen LGV if at all. Especially if you have had contact with anyone who has had sexual contact with someone in Asia, South America or the Caribbean. I hope this long winded message might be able to help someone. Seek medical attention Worried Wells! Don't wait and worry!

Response from Dr. Frascino

Hello,

Thanks for your post.

LGV (lymphogranuloma venereum) has been relatively uncommon in industrialized nations, aside from some cases reported from the Netherlands and the United Kingdom. However, in February the CDC did report six cases in the United States. Since then, other cases have been popping up, mainly in gay and bisexual men. Among the U.S. cases reported so far, most have also had HIV/AIDS. Symptoms of LGV can include flu-like symptoms and a painful bloody rectal infection. Genital ulcers can also occur as can painful draining lymph nodes in the groin area. If identified early, LGV can be treated fairly easily with antibiotics. Left untreated, it can cause permanent damage to the bowels and disfigurement of the genitals (elephantiasis). LGV is a rare form of chlamydia and can be difficult to definitively diagnose.

I agree it's worth mentioning LGV to your doctor as a possibility, if you have symptoms that are consistent with this STD.

Good luck!

Dr. Bob



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