Last reviewed: 16 Apr 2021
Last updated: 01 Nov 2019



History and exam

Key diagnostic factors

  • presence of risk factors
  • inguinal lymphadenopathy
  • non-specific symptoms of proctocolitis
  • groove sign of Greenblatt
  • genital elephantiasis, saxophone penis, esthiomene

Other diagnostic factors

  • fever, malaise, arthralgias
  • lower abdominal or lower back pain
  • genital or anal ulcer
  • non-specific symptoms of bacteraemic spread
  • erythema nodosum
  • anogenital sinus tracts, strictures, or fistulae

Risk factors

  • other STDs
  • risky sexual behaviour
  • HIV-seropositivity
  • age (20 to 40 years)
  • unprotected intercourse in an area endemic for LGV
  • male

Diagnostic investigations

1st investigations to order

  • genital or lymph node specimens for nucleic acid amplification test (NAAT)
  • serum for complement fixation
  • serum for micro-immunofluorescence (MIF)
  • swab via anoscopy for Gram staining

Investigations to consider

  • STD testing
  • fluid or swab for real-time polymerase chain reaction (RT-PCR)
  • biopsy via proctosigmoidoscopy with histopathology
  • CT of abdomen and pelvis
  • MRI of abdomen and pelvis
  • fluid or swab for culture

Emerging tests

  • fluid or swab for genovar typing

Treatment algorithm


Attending Physician

Division of Hospital Medicine

MedStar Georgetown University Hospital




BDL declares that he has no competing interests.

Dr Benjamin D. Lorenz would like to gratefully acknowledge Dr Mettassebia Kanno, a previous contributor to this topic.


MK declares that she has no competing interests.

Peer reviewersVIEW ALL

Department of General Internal Medicine

Leiden University Medical Centre


The Netherlands


CvN declares that he has no competing interests.


Department of Obstetrics and Gynecology

Virginia Commonwealth University




DC declares that he has no competing interests.

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