Lymphogranuloma Venereum (LGV)
LGV is a chronic, systemic sexually transmitted infection caused by Chlamydia trachomatis serovars L1, L2, and L3. It is characterized by invasive infection of the lymphatic system.
Clinical Stages
| Stage | Key Findings |
|---|---|
| Primary | Small, painless papule or ulcer at the site of inoculation; often transient and unnoticed. |
| Secondary | Painful, inflammatory inguinal lymphadenopathy (buboes). The “Groove Sign” (inguinal ligament separating nodes) may be present. |
| Tertiary | Strictures, fistulas, and chronic proctocolitis, particularly in cases of rectal exposure. |
Diagnostic Pearls
- The “Groove Sign”: A physical exam finding where the inguinal ligament divides the enlarged femoral and inguinal nodes. It is highly suggestive of LGV.
- Diagnosis: Nucleic acid amplification testing (NAAT) is the preferred method for detecting C. trachomatis; specific genotyping can confirm the L-serovar.
High-Yield Exam Pearl:
- Management: Unlike uncomplicated chlamydia infections, LGV requires a longer course of therapy, typically Doxycycline for 21 days.
- Proctitis: Always consider LGV in a patient presenting with bloody/mucoid rectal discharge and tenesmus, even in the absence of obvious external genital lesions.