References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
Lymphogranuloma venereum (LGV) is an STI caused by specific strains of chlamydia (serovars L1, L2 and L3). Unlike ordinary chlamydia, LGV invades deeper tissues and causes more severe symptoms, including painful swollen lymph nodes, rectal inflammation and genital ulcers. It requires a longer course of treatment than standard chlamydia.
LGV is most commonly seen in men who have sex with men (MSM) in the UK, often alongside HIV. Here’s what to know.
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How LGV Is Spread
LGV is transmitted through unprotected vaginal, anal or oral sex. Rectal LGV is the most common form seen in the UK, usually acquired through receptive anal sex.
Symptoms
Rectal LGV (most common in UK)
- Rectal pain and bleeding
- Mucous or bloody discharge from the anus
- Feeling of needing to pass stools frequently (tenesmus)
- Constipation
- Can mimic inflammatory bowel disease
Genital LGV
- A painless ulcer or sore at the site of infection (often missed)
- Followed by painful swollen lymph nodes in the groin (buboes)
- The swollen nodes can form abscesses if untreated
| Stage | Timing | Symptoms |
|---|---|---|
| Primary | 3-30 days after exposure | Small painless ulcer (often unnoticed) |
| Secondary | 2-6 weeks later | Painful lymph nodes, rectal symptoms, fever |
| Tertiary (if untreated) | Months to years | Chronic inflammation, scarring, fistulas |
Diagnosis
LGV is diagnosed by:
- Testing positive for chlamydia on a rectal or genital swab (NAAT)
- The sample is then sent for LGV-specific typing to confirm the serovar
If you have rectal chlamydia symptoms, your clinic should test for LGV specifically.
Treatment
LGV requires a longer course of antibiotics than standard chlamydia:
- Doxycycline 100mg twice daily for 21 days (the standard treatment)
- Alternative: azithromycin or erythromycin if doxycycline isn’t suitable
Standard chlamydia treatment (7 days of doxycycline or single-dose azithromycin) is not enough for LGV.
Partner Notification
Sexual partners from the past 3 months should be contacted, tested and treated. Your clinic can help with this.
Read more: What is chlamydia? | What is gonorrhoea? | What is syphilis?
Frequently Asked Questions
Is LGV the same as chlamydia?
LGV is caused by specific strains of chlamydia that are more aggressive. It needs longer treatment and causes more severe symptoms than ordinary chlamydia.
Can women get LGV?
Yes, though it’s much less commonly diagnosed in women in the UK. The symptoms can be different and may be harder to recognise.
Will LGV come back after treatment?
Not if treated properly with the full 21-day course. Re-infection is possible if you’re re-exposed to an infected partner.
Related reading
- Abnormal Genital Discharge and Chlamydia
- Can Mycoplasma Genitalium Be Cured?
- Can You Get Chlamydia From Kissing?
- Can You Have Chlamydia and Test Negative?
- Chlamydia and Gay Men: What to Know
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
