Lymphogranuloma venereum (LGV) is caused by Chlamydia trachomatis types L1, L2, and L3. It is most often sexually transmitted.

LGV is most common in Southeast Asia, Africa, Central America, and the Caribbean. LGV accounts for 2% to 10% of genital ulcer disease in India and Africa.

An inconspicuous cutaneous ulceration occurs at the site of inoculation, and it often heals without being noticed.

Evanescent papulopustule or ulceration occurs.

The primary lesion, if present, is found on the penis, vaginal wall, cervix, or perirectally. It is rarely seen in women.

Regional lymphadenitis is characteristic. The groin fold divides lymph nodes into upper and lower groups (“the groove sign”) (Fig. 28.23). Sometimes, the adenopathy is bilateral.

Fluctuance and sinus tracts may develop.

LGV may be associated with malaise and joint stiffness.

Scarring may result in genital lymphedema.

Erythema nodosum occurs in 10% of women with LGV.

Rectal exposure can lead to proctocolitis, which if not treated promptly may lead to chronic colorectal strictures and fistulas.

The diagnosis of LGV depends mainly on the exclusion of other causes of suppurative adenopathy and serologic testing: a complement fixation test and two immunofluorescent tests.

Culture of the organism is also available.