Last reviewed: 20 Sep 2020
Last updated: 01 Nov 2019



History and exam

Key diagnostic factors

  • inguinal lymphadenopathy
  • nonspecific 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
  • nonspecific symptoms of bacteremic spread
  • erythema nodosum
  • anogenital sinus tracts, strictures, or fistulae

Risk factors

  • other STDs
  • risky sexual behavior
  • 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 microimmunofluorescence (MIF)
  • swab via anoscopy for Gram staining
More 1st investigations to order

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
More investigations to consider

Emerging tests

  • fluid or swab for genovar typing
More emerging tests

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.

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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