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LGV and Its Overlap with Crohn’s Disease & IBD

LGV - ACT

Understanding the Importance of LGV Testing for MSM Diagnosed with Crohn’s or IBD


Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by Chlamydia trachomatis serovars L1–L3. LGV can cause proctitis, which often mimics inflammatory bowel diseases (IBD) such as Crohn’s disease (CD) and ulcerative colitis. If you are a man who has sex with men (MSM) and have been diagnosed with Crohn’s or IBD, it is critical to ensure that you have been properly tested for LGV.

Histologic Similarities Between LGV Proctitis and IBD

LGV proctitis can present with symptoms that are nearly identical to Crohn’s disease, including rectal pain, bleeding, diarrhea, and ulceration. Histopathological studies have demonstrated significant overlap, with LGV mimicking the granulomatous inflammation and mucosal ulceration seen in Crohn’s disease (Hu et al., 2010; De Vries et al., 2008). Due to these similarities, LGV may be misdiagnosed as IBD based on standard histologic examination.

The Need for Special Staining in Biopsy Analysis

Routine biopsies taken during colonoscopy may misidentify LGV proctitis as Crohn’s disease unless specific tests are performed. Standard hematoxylin and eosin (H&E) staining does not differentiate LGV from Crohn’s disease. However, Chlamydia trachomatis can be detected using immunohistochemical (IHC) staining or polymerase chain reaction (PCR) testing on rectal biopsy samples, which are not typically ordered unless specifically requested (Domeika et al., 2010).

Why This Matters More if You Are Diagnosed After Age 30

Crohn’s disease is typically diagnosed in early adulthood, most commonly between the ages of 15 and 30. If you receive a new Crohn’s or IBD diagnosis after the age of 30, particularly as an MSM, there is an increased likelihood that your symptoms may be due to an undiagnosed LGV infection rather than true IBD (De Vries et al., 2008).

Many Providers Are Unaware of LGV Proctitis and How to Test for It

Despite increasing reports of LGV cases among MSM, many healthcare providers are still unaware of its clinical presentation and the necessary diagnostic tests. Standard sexually transmitted infection (STI) panels do not include LGV-specific testing, and LGV is often overlooked when assessing proctitis symptoms. If you have been diagnosed with Crohn’s or IBD and have not been specifically tested for LGV, you should ask your provider about LGV PCR testing from a rectal swab or biopsy sample.

What You Can Do

  • Ask for LGV testing. If you have proctitis symptoms, request an LGV-specific PCR test.

  • Discuss special staining. If you have had a biopsy, ask your provider about additional tests like IHC staining for Chlamydia trachomatis.

  • Be proactive. If you were diagnosed with Crohn’s disease after 30, consider the possibility of LGV and discuss it with your healthcare provider.

  • Seek specialized care. STI clinics or infectious disease specialists may be more familiar with LGV testing.

References

  • De Vries, H. J. C., Zingoni, A., Kreuter, A., Moi, H., & White, J. A. (2008). Lymphogranuloma venereum proctitis. Sexually Transmitted Infections, 84(3), 179–185.

  • Domeika, M., Savicheva, A., Sokolovsky, E., Ballard, R., & Unemo, M. (2010). Guidelines for the laboratory diagnosis of Chlamydia trachomatis infections in East European countries. Acta Dermato-Venereologica, 90(5), 461–475.

  • Hu, Y., Mathews, C., Tong, W. C., O'Mahony, C., & White, J. A. (2010). Histopathological features of rectal lymphogranuloma venereum infection in HIV-positive men. Histopathology, 57(6), 904–912.

For more information, consult your healthcare provider or a specialist in infectious diseases.

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