Lymphogranuloma venereum

Primary manifestation of lymphogranuloma venereum infection is painless penile or vulvar inflammation and ulceration at the site of inoculation; often not noticed by the patient.

Secondary stage typically occurs weeks after development of the primary lesion; presents as painful, unilateral, inguinal or femoral lymphadenopathy (often referred to as 'inguinal syndrome').

Proctocolitis has emerged as a more typical presentation in men who have sex with men (particularly those who are HIV-positive).

Chronic inflammation can lead to scarring and fibrosis causing lymphoedema of the genitals, or formation of strictures and fistulae if anorectal involvement.

Identification of Chlamydia trachomatis from the swab of a genital ulcer or aspiration of a bubo is definitive diagnosis.

Doxycycline is the preferred first-line treatment; macrolides are an alternative treatment option (e.g., in pregnant or lactating women, or patients with allergies to tetracyclines).

Large buboes may be aspirated, but incision and drainage or surgical excision of buboes may complicate healing.

Lymphogranuloma venereum (LGV) is a STI caused by Chlamydia trachomatis genovars/serovars L1, L2, or L3 (collectively termed the 'LGV biovar'), which are endemic to the tropics, but now emerging in developed regions. Infection occurs through contact with mucous membranes or abrasions in the skin of the genital region.