Lymphogranuloma Venereum (LGV) Dangerous? Causes, symptoms, treatment methods 2025

Lymphogranuloma Venereum (LGV)—known in Thai as “Fhee Ma Muang”—is a less common but serious sexually transmitted infection (STI) that can lead to long-term complications if not treated properly. Its early symptoms are often subtle, causing many cases to go unnoticed until swelling, pain, or abscesses appear in the groin.

This article provides a comprehensive overview of LGV, covering causes, symptoms, diagnostic methods, treatment, self-care, and how to prevent

What is Lymphogranuloma Venereum (LGV)?

Lymphogranuloma Venereum (LGV) is a sexually transmitted infection caused by invasive serovars (L1, L2, and L3) of Chlamydia trachomatis, which differ from the strains that typically cause uncomplicated urogenital chlamydia.

This infection primarily affects the lymphatic system, leading to swollen, inflamed, and tender lymph nodes in the groin, usually on one side. In Thailand, this condition is colloquially referred to as “Fhee Ma Muang”, which translates to “mango abscess,” describing the characteristic bulge resembling the shape of a mango.

LGV is most commonly seen in individuals with high-risk sexual behaviors, especially men who have sex with men (MSM). It can be transmitted through unprotected vaginal, anal, or oral sex.

Although LGV is less common than other STIs such as gonorrhea or syphilis, it is potentially serious. Without prompt medical treatment, it can lead to complications including ruptured lymph nodes with pus discharge, fistulas, chronic inflammation, or lymphatic obstruction.

What Are the Symptoms of Lymphogranuloma Venereum (LGV)?

The symptoms of Lymphogranuloma Venereum (LGV) vary depending on the stage of infection. The disease progresses through three distinct phases, each with its own clinical presentation:

Stage 1: Painless Genital or Rectal Ulcer

The initial lesion is typically a small, painless sore that appears at the site of infection—commonly the genitals, rectum, or mouth (if oral contact occurred). It often goes unnoticed and heals spontaneously within 1 to 3 weeks.

Stage 2: Painful Swollen Lymph Nodes (Groin Buboes)

This phase begins about 2 to 4 weeks after exposure. The lymph nodes in the groin become swollen, red, warm, and tender. In some cases, multiple nodes fuse together forming large masses known as buboes. Additional systemic symptoms such as fever, chills, and body aches may accompany this stage.

Stage 3: Chronic Lymphatic Complications

If left untreated, the infection may cause long-term damage to the lymphatic system, leading to scarring, obstruction, and chronic swelling. Complications may include genital ulcers, anal fistulas, or lymphatic strictures, especially in patients with prolonged untreated infection.

Symptoms become more apparent over time. If you notice unusual lumps, sores, or persistent swelling in the groin area—especially with fever—it is crucial to seek medical evaluation for accurate diagnosis and prompt treatment.

Is LGV Considered a Sexually Transmitted Infection (STI)?

Lymphogranuloma Venereum (LGV) is directly classified as a sexually transmitted infection (STI) and is closely associated with other STIs such as gonorrhea, chlamydia, syphilis, and HIV. These infections share common modes of transmission and frequently coexist—especially among men who have sex with men (MSM).

LGV is sometimes mistaken for a regular groin abscess or swollen lymph node, leading to missed opportunities for full STI screening. In reality, the presence of LGV is often a red flag signaling the need to test for additional infections.

Common co-infections with LGV include:

• HIV, which shares the same high-risk demographic
• Chlamydia (non-invasive serovars)
• Gonorrhea (Neisseria gonorrhoeae)
• Syphilis (Treponema pallidum)

For this reason, when LGV is suspected, comprehensive STI testing is strongly recommended. Early detection of co-infections ensures more effective treatment and reduces the risk of onward transmission to sexual partners.

Who Is at Risk for Lymphogranuloma Venereum (LGV)?

Although Lymphogranuloma Venereum (LGV) is relatively uncommon in the general population, certain individuals are at higher risk and should take preventive measures, undergo regular screenings, and seek prompt medical attention if any symptoms arise.

Men who have sex with men (MSM)

LGV is frequently reported among MSM, especially those who engage in diverse sexual behaviors such as having multiple partners or practicing unprotected sex.

Individuals with a history of STIs

A prior diagnosis of syphilis, gonorrhea, chlamydia, or HIV increases the likelihood of contracting LGV due to compromised mucosal barriers that make infection more likely.

Those who engage in unprotected sex

Sexual activity without condoms—whether vaginal, anal, or oral—significantly increases the risk of LGV transmission.

Immunocompromised individuals

People living with HIV or those on immunosuppressive therapies may be more vulnerable to severe or complicated infections.

Residents in outbreak-prone areas

LGV outbreaks may occur in specific geographic areas or within high-risk communities, such as urban centers or STI specialty clinics.

How Is LGV Different from Other Types of Groin Lumps?

Swelling or lumps in the groin or genital area can arise from various causes, but Lymphogranuloma Venereum (LGV) has distinct features that help differentiate it from other common conditions. Recognizing these differences can guide individuals to seek timely medical care.

Comparison between LGV and other causes of groin lumps:

A key distinguishing factor is that LGV lumps are often linked to recent sexual activity and show more intense inflammation. Self-assessment may be misleading, so professional medical evaluation is essential for accurate diagnosis.

How Is LGV Diagnosed?

Diagnosing Lymphogranuloma Venereum (LGV) requires a combination of thorough medical history-taking, physical examination, and specific laboratory tests to confirm the infection and differentiate it from other similar conditions.

1. Medical history and physical exam

The physician will ask about sexual history—especially receptive anal sex or male-to-male sexual activity (MSM)—and look for symptoms typical of LGV, such as a prior painless ulcer followed by swollen groin lymph nodes.

2. Swab from lesions or discharge

If genital or rectal sores are present, samples will be collected to detect Chlamydia trachomatis using NAAT (Nucleic Acid Amplification Test), the gold standard for accuracy.

3. Blood tests

Additional blood work may be performed to identify antibodies or screen for co-infections like HIV, syphilis, or gonorrhea, which are often found alongside LGV.

4. Referral to specialist clinics

In areas where LGV is rare, patients may be referred to sexual health clinics or STI specialists for advanced testing, including genotyping to confirm the invasive LGV strains.

Early and accurate diagnosis is crucial to prevent complications. Delayed treatment may result in chronic issues that are more difficult to manage.

How Is LGV Treated?

The goal of treating Lymphogranuloma Venereum (LGV) is to eliminate the bacterial infection, reduce inflammation in the lymph nodes, and prevent long-term complications.

Oral antibiotic therapy

The standard first-line treatment is Doxycycline 100 mg twice daily for 21 days, as recommended by the CDC and WHO. Doxycycline is highly effective in eradicating the invasive Chlamydia trachomatis strains.

For patients who cannot take doxycycline, alternatives such as Azithromycin or Erythromycin may be prescribed, depending on the clinical situation and tolerance.

Management of buboes or abscesses

In cases with large, painful swollen lymph nodes or abscesses (buboes), the physician may perform needle aspiration or surgical drainage to relieve pain and prevent complications. This is done alongside antibiotic therapy.

Partner treatment

Sexual partners who had contact with the patient within the 60 days prior to symptom onset should be tested and treated—even if asymptomatic—to prevent reinfection and further transmission.

Avoiding sexual contact during treatment

Abstinence from all forms of sexual activity is strongly advised until the treatment is complete and a physician confirms recovery, to avoid reinfecting partners or spreading the disease.

With prompt treatment, LGV typically resolves without lasting effects. However, delayed or incomplete therapy can lead to chronic complications that are more difficult to manage

How to Take Care of Yourself While Recovering from LGV

Although antibiotics are the cornerstone of LGV (Lymphogranuloma Venereum) treatment, proper self-care during recovery plays a vital role in reducing symptoms, supporting the immune system, and preventing complications—especially when swelling, pain, or open sores are present.

1. Get adequate rest

Ensure you sleep at least 7–9 hours per night. Rest helps your immune system work optimally alongside antibiotic therapy.

2. Apply warm compresses to reduce swelling

Use a warm, damp cloth to gently compress swollen lymph nodes in the groin for 15–20 minutes, two to three times daily. This can relieve pain, ease tension, and improve circulation.

3. Keep affected areas clean

If open sores or draining abscesses are present, gently clean them once or twice daily with saline or clean water. Avoid using harsh soaps or strong antiseptics that may irritate the skin.

4. Avoid sexual activity

Abstain from all forms of sexual contact until your healthcare provider confirms that the infection has cleared. This helps prevent reinfection and protects partners.

5. Eat foods that support immune function

Consume a balanced diet rich in protein, vitamin C, and zinc—such as fish, legumes, and citrus fruits—to accelerate healing. Avoid fermented foods, alcohol, and overly spicy meals during active inflammation.

How Long Does It Take to Recover from LGV?

If treatment starts early

When antibiotics such as doxycycline are started within 1–2 weeks of symptom onset, most patients recover in 21 days without lasting effects or complications.

If there is severe swelling or abscess

In cases involving large buboes or drained abscesses, recovery may take 3–5 weeks, depending on wound care and the body’s response to medication.

If treatment is delayed

If LGV is left untreated for several weeks or months, the condition may progress to a chronic stage, requiring months of treatment and monitoring due to the risk of scarring or persistent ulcers.

Can it heal on its own?

While mild symptoms may seem to improve spontaneously, the bacteria often remain active in the lymphatic system, posing long-term risks. Without proper treatment, complications and transmission are still possible.

The shortest and most successful recovery periods occur in patients who seek medical attention promptly and follow treatment and self-care instructions closely.

 Can LGV Recur After Treatment?

Recovery from LGV does not confer lasting immunity. Reinfection can occur if the patient is exposed again—commonly from untreated partners or unprotected sex.

Risk of recurrence

Those previously infected may recognize symptoms earlier the second time, but recurrence is often harder to detect. LGV may present differently in subsequent infections, sometimes with milder or atypical symptoms that delay diagnosis.

Factors that increase recurrence

• Sexual partners not treated simultaneously
• Resuming sexual activity too early
• Not using condoms consistently
• Skipping follow-up testing

How to prevent recurrence

• Ensure all sexual partners receive testing and treatment
• Avoid sex until cleared by a physician
• Attend follow-up testing (e.g., at 3 months post-treatment)
• Adopt safer sex practices long-term

When Should You See a Doctor for LGV?

Seek medical attention immediately if you experience:

• Rapidly enlarging, painful, red, or warm lumps in the groin
• A painless sore on the genitals, rectum, or mouth that doesn’t heal within a week
• Fever, body aches, or fatigue accompanying groin swelling
• Pus or discharge from a swollen lymph node
• Sexual contact with someone diagnosed with LGV or another STI

Consider proactive testing—even if you have no symptoms—if you:

• Engage in unprotected sex
• Have multiple or anonymous sexual partners
• Are a man who has sex with men (MSM)
• Have a history of STIs

Where to go for evaluation

Start with a general clinic or a sexual health (STD) clinic.

How Much Does LGV Treatment Cost?

The cost of treating Lymphogranuloma Venereum (LGV) varies depending on the type of medical facility, the severity of the condition, and the diagnostic and treatment methods used. 

Estimated cost: ฿2,000 – ฿6,000.

• Initial consultation
• Laboratory tests (e.g., NAAT, PCR)
• Medications (e.g., 21-day course of doxycycline)
• Follow-up appointments

If incision and drainage of abscesses are required, additional procedural fees may range from ฿1,000 – ฿3,000.

Additional STI screening

Testing for co-infections such as HIV, syphilis, or gonorrhea will increase the total cost, especially at specialized STD clinics.

Can health insurance cover it?

Some private health insurance plans may cover STI testing and treatment, but it’s important to check your policy terms carefully as exclusions often apply.

Is LGV Different in Children Compared to Adults?

LGV in adults

In adults, LGV typically results from direct sexual transmission. Symptoms begin with a sore on the genitals or rectum, followed by swollen lymph nodes. Adults can usually describe their sexual history, aiding accurate diagnosis and targeted treatment.

LGV in children

The presence of LGV in children is rare and is considered a red flag for potential sexual abuse. Thorough evaluation is essential, involving a multidisciplinary team including pediatricians, social workers, and child psychiatrists.

Symptom differences

Children may not be able to articulate symptoms clearly, and early signs such as ulcers may go unnoticed—leading to delayed diagnosis until the lymph nodes are significantly enlarged.

Approach to care

• Adults: Focus on antibiotic therapy and self-care
• Children: Requires not only medical treatment but also psychological support and a comprehensive review of the child’s safety and circumstances

Conclusion

While LGV may not be widespread, early diagnosis and timely treatment are critical to prevent severe complications that may arise from delayed care.

Whether you’re experiencing groin swelling, belong to a high-risk group, or simply want peace of mind—seeing a doctor is the best course of action. Being informed about LGV not only protects your own health but also helps prevent its spread within the community.

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