Herpes vs LGV (lymphogranuloma venerum)

Written and reviewed by Slava Fuzayloff | Published on June 2, 2024

LGV is more common in tropical countries than in the United States. In the U.S., LGV mainly affects homosexuals, with the rectum being the most commonly affected area.

LGV is a disease of lymph nodes that begins with a sore. LGV has two stages: primary and secondary. [5] Lymphogranuloma venereum (LGV) https://www.cdc.gov/std/treatment-guidelines/lgv.htm A few asymptomatic weeks pass between the first and second stages.

Primary LGV can present as a sore, so this will be the focus of our attention here.

When we (doctors) try to differentiate between two medical conditions, we compare two parts of those diseases: history and the visual exam. What does each part mean?

1. History is about:

✓ What caused the rash?

✓ How soon did the rash appear after exposure (the rash incubation period)?

✓ How are the rash and other symptoms changing over time?

2. Visual exam is when we:

✓ Look at the rash

✓ Notice the location of the rash

✓ Pay attention to any discharge from the lesion

✓ Skin depth affected by the lesion

In medical practice, 90% of diagnoses are based on a visual exam and 10% on the history of the rash. So, the history of the rash plays a confirmatory role.

This infographic provides a summary of the comparison between genital herpes and LGV (Lymphogranuloma venerum)

History

What caused the rash?

Both conditions are infectious and transmitted via skin-to-skin contact. Therefore, this is not a differentiating factor.

How soon do the symptoms appear?

Unlike herpes, which has an average incubation period of 2–4 days, the primary LGV incubation period can be as long as 7–12 days. [6] Lymphogranuloma Venereum https://www.ncbi.nlm.nih.gov/books/NBK537362/

How are symptoms evolving?

There is a significant difference in how these two conditions progress over time.

Both conditions can start with elevated bumps that turn into ulcers. After that, they evolve differently:

✓ Unlike a herpes skin flare-up, preceded by prodrome symptoms and “nerve pain,” LGV has no preceding signs and symptoms. [1, 5] Genital Herpes – CDC Detailed Fact Sheet
https://www.cdc.gov/std/herpes/stdfact-herpes-detailed.htm
Lymphogranuloma venereum (LGV)
https://www.cdc.gov/std/treatment-guidelines/lgv.htm

✓ Unlike herpes skin lesions, which go from one stage to another (bumps, blisters, sores, crusted sores), LGV sores stay in one stage (ulcer) for a prolonged period (a few months).

✓ Unlike with herpes, LGV symptoms (swollen, painful lymph nodes and discharge) appear only after the initial sore heals. [2, 6] Genital Herpes Symptoms, Pictures, and Treatment
https://www.webmd.com/genital-herpes/ss/slideshow-genital-herpes
Lymphogranuloma Venereum
https://www.ncbi.nlm.nih.gov/books/NBK537362/

✓ Unlike herpes skin lesions, which are constantly painful, the initial skin sore with LGV does not hurt.

✓ Unlike herpes, which presents with painful groin lymph node enlargement, with the initial LGV sores, there is no lymph node enlargement. The lymph nodes become enlarged and painful with LGV during the second stage, after the initial skin sore has healed. A few asymptomatic weeks pass between the first and second stages.

✓ Unlike herpes lesions, which take one week to heal, the healing time for the primary LGV lesion is a few days. [3, 4] Genital herpes: Overview
https://www.ncbi.nlm.nih.gov/books/NBK525769/
Lymphogranuloma venereum (LGV)
https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/lymphogranuloma-venereum-lgv

These pictures show the differences between herpes and lymphogranuloma venerum.

Warning

Contains sensitive content

View Photos

Herpes

Lymphogranuloma Venerum

Visual exam

What do the lesions look like?

Unlike herpes sores, which are multiple and clustered [3] Genital herpes: Overview https://www.ncbi.nlm.nih.gov/books/NBK525769/ ,an LGV sore is usually singular.

What are the stages?

Herpes skin lesions go from one stage to several others, but an LGV lesion starts as a blister that rapidly turns into a small, soft, painless ulcer.

What is the discharge like?

Both herpes and primary LGV sores do not have any significant discharge. LGV will have considerable discharge in the second stage, 2–6 weeks after the sore has healed.

Genital Herpes – CDC Detailed Fact Sheet
https://www.cdc.gov/std/herpes/stdfact-herpes-detailed.htm
Genital Herpes Symptoms, Pictures, and Treatment
https://www.webmd.com/genital-herpes/ss/slideshow-genital-herpes
Genital herpes: Overview
https://www.ncbi.nlm.nih.gov/books/NBK525769/
Lymphogranuloma venereum (LGV)
https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/lymphogranuloma-venereum-lgv
Lymphogranuloma venereum (LGV)
https://www.cdc.gov/std/treatment-guidelines/lgv.htm
Lymphogranuloma Venereum
https://www.ncbi.nlm.nih.gov/books/NBK537362/