Summary

• Primary manifestation of infection is painless penile or vulvar inflammation and ulceration at the site of inoculation; often not noticed by patient.
• Secondary stage typically occurs weeks after development of the primary lesion; presents as painful, unilateral, inguinal or femoral lymphadenopathy (often referred to as "inguinal syndrome").
• May occasionally present as proctocolitis in men who have sex with men (particularly those who are HIV-positive) and also in women.
• Chronic inflammation can lead to scarring and fibrosis causing lymphoedema of the genitals, or formation of strictures and fistulae if anorectal involvement.
• Identification of Chlamydia trachomatis from the swab of a genital ulcer or aspiration of a bubo is definitive diagnosis.
• Doxycycline is the preferred first-line treatment; macrolides are an alternative treatment option (e.g., in pregnant or lactating women, or patients with allergies to tetracyclines).
• Large buboes may be aspirated, but incision and drainage or surgical excision of buboes may complicate healing.