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Lymphogranuloma venereum

Last reviewed: 5 Sep 2023
Last updated: 12 Aug 2022



History and exam

Key diagnostic factors

  • inguinal lymphadenopathy
  • nonspecific symptoms of proctocolitis
  • groove sign of Greenblatt
  • genital elephantiasis, saxophone penis, esthiomene
More key diagnostic factors

Other diagnostic factors

  • fever, malaise, arthralgias
  • lower abdominal or lower back pain
  • genital or anal ulcer
  • nonspecific symptoms of bacteremic spread
  • erythema nodosum
  • anogenital sinus tracts, strictures, or fistulae
Other diagnostic factors

Risk factors

  • other STIs
  • risky sexual behavior
  • HIV-seropositivity
  • age (20 to 40 years)
  • unprotected intercourse in an area endemic for LGV
  • male
More risk factors

Diagnostic investigations

1st investigations to order

  • genital or lymph node specimens for nucleic acid amplification testing (NAAT)
  • swab via anoscopy for Gram staining
  • fluid or swab for LGV-specific molecular testing
  • STI testing
More 1st investigations to order

Investigations to consider

  • endoscopy with histopathology
  • serum for complement fixation
  • serum for microimmunofluorescence (MIF)
  • CT of abdomen and pelvis
  • MRI of abdomen and pelvis
  • fluid or swab for culture
More investigations to consider

Emerging tests

  • fluid or swab for genovar typing

Treatment algorithm


asymptomatic adolescent and adult patients who have been exposed to lymphogranuloma venereum (LGV)


all stages of lymphogranuloma venereum (LGV)



Benjamin D. Lorenz, MD

Assistant Professor

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 reviewers

Cees van Nieuwkoop, MD

Department of General Internal Medicine

Leiden University Medical Centre


The Netherlands


CvN declares that he has no competing interests.

David Chelmow, MD


Department of Obstetrics and Gynecology

Virginia Commonwealth University




DC declares that he has no competing interests.

  • Lymphogranuloma venereum images
  • Differentials

    • Syphilis (Treponema pallidum)
    • Gonococcal proctitis
    • Genital herpes (HSV)
    More Differentials
  • Guidelines

    • Sexually transmitted infections treatment guidelines, 2021
    • 2019 European guideline on the management of lymphogranuloma venereum
    More Guidelines
  • Patient leaflets


    More Patient leaflets
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