Transmitted sexually through vaginal, anal, or oral contact
Epidemiology
Uncommon in Canada but more common in parts of Africa, Asia, South America, and the Caribbean
Occasional outbreaks among men who have sex with men
Clinical Manifestations
Primary LGV
Incubation period 3 to 30 days
Starts with small painless papule at site of inoculation that may ulcerate
Only noticed in 50% of patients
Secondary LGV
Latency of 2 to 6 weeks from primary lesion
Presents with systemic symptoms, including fevers and chills, malaise, myalgias, and arthralgias
May have abscess with or without draining sinuses
Occasionally involves arthritis, pneumonitis, hepatitis, and rarely involves carditis, aseptic meningitis, or ocular inflammation
Secondary LGV With Lymphadenopathy
Most commonly involves painful inguinal or femoral lymphadenopathy, called "buboes"
The "groove sign", where nodes are seen above and below the inguinal ligament, is highly specific for LGV
Secondary LGV With Anorectal Symptoms
Presents with acute hemorrhagic proctitis
May also cause constipation
Tertiary LGV
Also called chronic LGV, and occurs in 10 to 20% of untreated patients
Characterized by chronic inflammation that causes:
Lymphadtic obstruction leading to genital elephantiasis
Genital and rectal strictures and fistulae
Can cause esthiomene, extensive destruction of genitalia
Investigations
Anoscopy/sigmoidoscopy/proctoscopy
Similar appearance to ulcerative colitis
Bubo aspiration
Usually contains small amount of milky fluid
Aspirate through healthy skin
Diagnosis
Typically done by diagnosing Chlamydia trachomatis and then confirming the serotype with the reference laboratory
Sample should be taken from swab of lesion (if primary), or bubo aspirate, swab of rectum, vagina, oropharynx, or urethra, or urine (if secondary or tertiary)
Chlamydia testing with culture or NAAT
Confirmatory testing with DNA sequencing or RFLP at a reference laboratory
Management
Do not treat with excision or incision and drainage
