Lymphogranuloma venereum (LGV) is caused by three subtypes of C. trachomatis: serovars L1, L2, or L3. It is most often seen in tropical areas of Asia, Africa, South America, and the Caribbean. Symptoms appear 3-30 days after infection, and usually present as a painless ulcer or papule at the site of inoculation. Inguinal and femoral lymphadenopathy may also occur. Rectal exposure can result in mucoid or hemorrhagic rectal discharge, painful bowel movements, and constipation. Late manifestations include rectal and perirectal inflammation that can lead to rectal strictures and rectovaginal and perianal fistulas. Constitutional symptoms, such as fever, may occur.
Diagnosis is based on clinical suspicion, epidemiologic information, and C. trachomatis testing. Genital and lymph node specimens (e.g., lesion swab, aspirate) may be tested for C. trachomatis by culture, direct immunofluorescence, or nucleic acid detection. To differentiate LGV from non-LGV C. trachomatis, special testing is generally necessary (e.g., genotyping) and may necessitate consultation with laboratory experts. Chlamydia serology (complement fixation titers >1:64 or microimmunofluorescence titers >1:256) can support the diagnosis in the appropriate clinical context.