[Question #1501] LGV?

81 months ago

I'm 43y man. I have regular women partner and sometimes MSM contacts (never anal-penetrative). The last MSM contact was 2y ago. Few days later I developed herpes\folliculitis like upper trunk rash, mild clear morning discharge and right testicular discomfort, and tiny white dots in the mouth. Before symptoms occurred, I had sex with regular partner. The symptoms led to stress and fear. I received antibiotics before tests (ceftriaxone/azithromycin/ doxy/moxifloxacin). Rash resolved rapidly but other symptoms resolved after negative blood and urinePCR. STD specialist concluded that symptoms were viral infection and stress related. The next year I was OK but always thought about the possibility of STD transmission to my partner.

1y later: My partner had a small bump inside labia minor that was manually drained with one drop of sebacious content. My fear about STD came back with discomfort and discharge. We received ceftriaxone/ azithromycin. After antibiotics she started tiny small vulvar tears after every contact, constipation, tiny (1-2mm) anal mucosa tear on defecation.  Gynecologist found candida and antifungals led to temporal effect. I also started tears on penis after intercourse. Additional ceftriaxone 1gr/azithromycin2gr/doxy200mg 18days only worsened symptoms. We tested negative (vaginal/urine PCR) and she had normal vulvoscopy. The symptoms stopped after antibiotics discontinuation. We have never had dysuria, lymphadenopathy, rectal discharge or tenesmus.

Last year I have right leg edema. Venous insufficiency was found, but laser treatment didn't improve edema.  I found that edema may be LGV complication even without early signs.  I recalled that 4 years ago I had small perianal abscess that was successfully surgically treated without recurrence or anal symptoms for 4 years(first operation led to fistula, and second resolved it completely).

Now we feel good. Sometimes I have morning clear discharge and right testicular minimal pain. Symptoms appear when I depressed and think about possible infection, or maybe I become depressed when they begin (I don't know what is the cause and what is the consequence). I had 4 tests and STD specialist said that I have nothing and this kind of discharge is normal. The only real and visible sign is leg edema. I have new (hope stupid) idea that edema is due to undiagnosed LGV and  I'm just waiting for the emergence of new complications.

May leg edema or aforementioned symptoms be LGV signs?

May LGV be transmitted by oral, oral/anal, penis/anal touching without penetration?

How can I rule out LGV?

H. Hunter Handsfield, MD
81 months ago
Welcome to the forum. Thanks for your question.

I'm sure your leg edema has nothing at all to do with LGV. Although there has been a resurgence of LGV in the last 10-15 years among men who have sex with men, even in them it is rare, and almost all cases are rectal infections. These do not lead to lymph blockage and edema in the legs. The only form of LGV known to do that is the genital-inguinal version, i.e. involving lymph nodes in the groin. Those have been extremely rare; I believe there have been no reported cases in the US in the past decade. And this form of LGV is always severely symptomatic -- there is no way you could have had a case sufficiently severe to affect lymph drainage in your leg without knowing it. It is a serious, painful condition. There are no known asymptomatic cases.

As for transmission, LGV is caused by a particular strain of chlamydia, and is transmitted sexually like all chlamydia:  vaginal or anal sex accounts for most cases, with rare ones by oral sex. Hand-genital contact or fingering are not known to ever transmit it. And routine chlamydia lab tests would pick it up if present. (Such testing doesn't automatically distinguish LGV from garden variety strains, but negative tests for chlamydia are conclusive.) On top of all that, in the very unlikely chance you had been exposed to or infected with an LGV strain of chlamydia, the treatments you describe,  with a couple of courses of azithromycin, doxycycline, or both, would have eradicated chlamydia, including an LGV strain, if you had it. No testing for LGV is necessary. (A blood test is available, but it takes special laboratory effort, and any past chlamydia sometimes can cause positive results -- so even if positive, it would not indicate active infection that needs medical attention. So really no point in it.

Finally, I agree with the advice you have had about your continuing on and off genital symptoms. You may have a compotnent of chronic prostatitis, which is not an STD and becomes increasingly common as men pass age 40. It is uncertain whether some STDs, especially chlamydia, gonorrhea, or some case of nongonococcal urethritis may predispose to prostatitis -- experts disagree about it. But if so, persisting STD itself isn't involved. In any case, such symptoms and even prostatitis are harmless; this will never cause an important health issue in you or your current or future sex partner(s). Your leg edema almost certainly is unrelated to any of this. You may need to learn to live with the symptoms you have, but you can be confident there will never be "emergence of new complications".

So my advice is to keep in touch with your STD specialist doctor if symptoms continue or you remain concerned. But I'm confident nothing serious is going on here.

I hope this has helped. Best wishes--  HHH, MD

81 months ago

Thank you for response.

I grew up in environment where homosexuality was prohibited like a crime. I thought that it is disease and tried to change my nature since teens. I'm married and love my wife very much, but cannot win myself. I had very short experience with males (never anal sex) and now I'm punished. I made this mistake and no one can judge me more than I judge myself.

STD specialist didn't know that my extramarital contact was with man and could make incorrect conclusions.   

My main fear is that I put in risk my partner. She had consultation with best gynecologist and everything was normal including vulvoscopy. He found only candida. She was tested with vaginal PCR and urine PCR- all neg. I don't know if this is enough to rule out infections.

I had 5 HIV tests during this year and 2 tests for HBV, HCV, HSV and antitreponemal Ab- all neg (6 weeks and 1year after last exposure). Antitreponemal Ab result is not so clear for me. I received multiple antibiotics a few days after exposure. Is it possible that antibiotics led to neg results but did not prevent Treponema transmission to my partner through the only contact that was between exposure and treatment? Does this test mean that I had no syphilis? Do you think that we have to do additional tests (syphilis or other)?

I asked you about LGV, but I want to clarify one question. I have never had inguinal swelling and lymph nodes were normal on CT scan (abdomen and chest). As I read LGV may lead to genital swelling. May it lead to isolated leg swelling without preceding nodes swelling and without genital swelling? Vascular specialist sure that swelling is vein related, but he did not perform tests for lymph drainage. He said that US-Doppler findings and edema distribution (only calf without foot and toes) are signs of venous insufficiency and not lymphedema.  We took doxy only for 18 days and not 21 as recommended (doxy was preceded by azithromycin). Should we take one more prolonged treatment?

My symptoms, including leg edema, are mild and in another situation I would not have paid attention. I obsessively search and read about STD and always find symptoms. Everything that we have I relate to possible STD.

Thank you.

H. Hunter Handsfield, MD
81 months ago
Be very clear:  you are not being "punished" for anything. And you have NO infection of any kind as a result of your sexual contact with men. All your tests for HBV, HCV, HSV, and syphilis prove you are not infected and therefore could not have infected your wife. If you ever had syphilis, you were cured before you could have transmitted it to your wife.

I have already answered these questions about LGV.  You do not have it and never did. Believe your vascular specialist:  all the evidence proves your edema is due to venous insufficiency and cannot be due to LGV.

"Everything that we have I relate to possible STD."  Wrong. NOTHING you have relates to possible STD. Further, my advice is in agreement with your own doctor. Your inability to believe or accept it is purely psychological and, frankly, irrational. You are doing your best to prove me wrong, that you really have put your life and your wife's health at risk. You have not. You need to separate your anxities and fears because of your upbringing, and about some sexual choices you regret, from possible medical consequences of them. Deal with the first part as you need to, perhaps with professional counseling. But do your best to disregard the health aspects. There are none. Believe it, accept it, and move on with your life. If you cannot, I strongly recommend professional counseling, which I suggest from compassion, not criticism.

Sorry if this sounds overly direct or even harsh. But I'm hoping to knock some rationality into your brain. I hope it works. Good luck.

H. Hunter Handsfield, MD
81 months ago
And for goodness' sake stop searching the internet about STDs or your symptoms. Like many anxious persons, you are being drawn to information that reinforces your fears and not seeing all the reassuring information that also is there. Just lay off online search about all this. It isn't worth it.
81 months ago

Thank you very much for your reply. I agree with everything you said. I'm sure that I most need is to make sure that I do not have an infection. Every time I get negative tests, I feel better, and so I understand that many of the symptoms are due to fear. All the tests have excluded infection, but I understand that there are no tests that can reliably exclude LGV.

Unilateral leg edema appeared 1 year after exposure. A week before the swelling I had a knee injury without fracture or ligament damage. One day prior to the appearance of edema, I took antibiotics (azithromycin 2gr and ceftriaxone1gr). I thought that the swelling can be due to injury or side effects of the antibiotic. 1 year passed, but edema is still here. So I started to think about LGV. Another explanation I have not found. I myself do not believe it. I'm very glad to know that you too do not believe that. I read case reports when complications (genital edema) appeared years after asymptomatic stage. I found case reports when LGV led to genital swelling but not to leg edema. I didn't find reports where leg edema was the only LGV presentation/complication.

I know that you answered all my questions but I want to use my third opportunity to talk with you and to reassure myself one more time.

Is it possible that perianal abscess that I had 4 years ago was bubonulus and resolved after surgery without antibiotics and without recurrence during 4 years? My LGV be silent for so long period?

May LGV lead to isolated leg edema without genital edema and without lymph node enlargement or pain?

Is doxy 100 bid 18 days (I took also azithromycin 5 days prior to doxy) sufficient for LGV? (I read that sometimes as long as 3 months of treatment is needed). May alcohol significantly reduce doxy effectiveness? 

May symptoms related to infection stay unchanged for 1 year without improvement or worsening?

I am very grateful for all your answers. It was very important to know your opinion. Your opinion helps me more than any tests or consultation and more than harmful and, may be unnecessary antibiotics.  

H. Hunter Handsfield, MD
81 months ago
You're abnormally obsessed with LGV. I can't say what might have caused your perianal abscess 4 years ago (I have never heard of "bobonulus"). LGV does not remain silent so long and indeed 18 days of doxycycline plus azithromycin for 5 days would have eradicated that strain of chlamydia if you had it. (Three months treatment is needed only for seriously complcated symptoms that take a long time to clear up.)

As I said above, you would be wise stop all internet searching about LGV. There is NOTHING you will find, or symptoms you may develop in the future, that would change the facts that you don't have it and never did; or that would change my or other experts opinions or advice. Let it go.

That ends this thead. Please do not start a new thread with any more questions about your concerns about LGV. Repetative anxiety driven questions are not permitted, and a new one would be deleted without reply.

Do your best to move on with your life. Good luck.