Continuing now with our discussion of sexually transmitted infections,
we turn to lymphogranuloma venereum.
This is a sexually transmitted infection characterized by
enlarged inguinal lymph nodes, or severe proctocolitis,
caused by distinct serovars or variants of the organism Chlamydia trachomatis.
This is a worldwide disease with over a hundred million cases per year worldwide.
The true incidence in the United States is unknown because
the national reporting of this condition ceased in 1995,
where we find it today most prevalent is among adolescent men and women
from the Caribbean, Central America, Southeast Asia, and Africa,
and as are many other sexually transmitted diseases,
are increasing among men who have sex with men.
A little bit about the organism.
As you well know, Chlamydia trachomatis is certainly a cause of non-gonococcal urethritis.
It is a cause of devastating eye disease called trachoma.
But lymphogranuloma venereum is caused by specific serovars --
L1, L2, and L3 of Chlamydia trachomatis --
and these serovars don’t cause the other diseases mentioned.
Like them, however, it’s an obligate intracellular bacterium,
which is able to replicate inside target eukaryotic cells.
Like the non-gonococcal urethritis version,
the infectious form is elementary bodies,
which attach to and enter epithelial cells,
and, in a vesicle, become reticulate bodies
where multiplication takes place
and the ultimate product is more elementary bodies
that are released from the infected cell and its next victim time.
So person-to-person transmission, intimate contact,
genital-to-genital is the usual.
And it turns out that Chlamydia trachomatis
cannot infect squamous epithelial cells,
so it’s going to target urogenital cells.
It gains entry through minute abrasions and lacerations.
The primary lesion is a tiny papule or even a herpetiform ulcer,
which may go completely unrecognized by the person who’s infected.
It’s not terribly symptomatic.
But from there, it goes to regional lymph nodes,
and that’s where it wreaks havoc.