Lymphogranuloma venereum

From IDWiki


  • Infection caused by Chlamydia trachomatis serovars L1, L2 and L3
  • Transmitted sexually through vaginal, anal, or oral contact


  • 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


  • Anoscopy/sigmoidoscopy/proctoscopy
    • Similar appearance to ulcerative colitis
  • Bubo aspiration
    • Usually contains small amount of milky fluid
    • Aspirate through healthy skin


  • 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


  • Do not treat with excision or incision and drainage
  • Antibiotics
  • Perform a test-of-cure at 3 to 4 weeks following completion of treatment
  • Also treat any sexual partners within the last 60 days
  • Also rule out other concurrent sexually-transmitted infections, including chancroid and donovanosis


  • Consistent use of condoms or other barrier methods, including for oral sex
  • Avoid mucosal trauma if possible