Lymphogranuloma venereum

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Clinical Features[1]

  • Incubation period 3-30 days
  • Stage 1 (Primary): Self-limited painless genital papule/ulcer (lasts ~1 week)
    • Seen on coronal sulcus in men, posterior vaginal fourchette in women
    • Can also occur in rectum (hemorrhagic proctitis), urethra, vagina
  • Stage 2 (Secondary): Painful inguinal and/or femoral lymphadenopathy (2-6 weeks after primary lesion)
    • Lymph nodes become necrotic → suppurative → formation of buboes
    • Systemic symptoms: fever, myalgia, malaise
      • Occasionally - arthritis, ocular, cardiac, pulmonary, aseptic meningitis, hepatitis
  • Stage 3 (Tertiary): Proctocolitis, anorectal syndrome
    • Usually manifests in women or men who have sex with men
    • Rectal pain, discharge, bleeding
    • Can also → fistula, abscess, strictures, megacolon

Differential Diagnosis


  • Nucleic Acid Amplification Tests (NAAT)
  • Immunofluorescence
  • Culture (needle aspiration of bubo)
  • Serology
  • Consider anoscopy
  • Also consider testing for HIV and other possible coinfections


  • Doxycycline 100mg PO BID x 21 days (first choice) OR
  • Erythromycin 500mg PO QID x 21 days OR
    • Preferred for pregnant and lactating females
  • Azithromycin 1g PO weekly for 3 weeks OR
    • Alternative for pregnant women - poor evidence for this treatment currently
  • Tetracycline, Minocycline, or Moxifloxacin (x21 days) are also acceptable alternatives to Doxycycline
  • Treat sexual partner


  • Discharge
  • Instruct patient to abstain from sexual activities until completion of treatment

See Also


  1. 1.0 1.1 Ceovic R, Gulin SJ. Lymphogranuloma venereum: diagnostic and treatment challenges. Infection and Drug Resistance. 2015;8:39-47. doi:10.2147/IDR.S57540.