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Lymphogranuloma venereum
See also in: Cellulitis DDx,Anogenital
Other Resources UpToDate PubMed

Lymphogranuloma venereum

See also in: Cellulitis DDx,Anogenital
Contributors: Paritosh Prasad MD, Tara Mahar MD, Art Papier MD, Lowell A. Goldsmith MD, MPH
Other Resources UpToDate PubMed


Lymphogranuloma venereum (LGV) is an uncommon sexually transmitted infection (STI) caused by the obligate intracellular bacteria Chlamydia trachomatis (serovars L1, L2, or L3). It is worldwide in distribution, but more commonly seen in tropical and subtropical countries. It can present with genital ulcerative disease, lymphadenopathy, or proctocolitis. There are also reports of asymptomatic infection.

There are 3 distinct stages in the course of the disease. In the first stage, after a 3- to 30-day incubation period, a small, painless papule or pustule develops that may erode to form an ulceration. This lesion is often asymptomatic and heals without scarring within 1 week.

The second or inguinal stage begins 2-6 weeks after the primary lesion and consists of painful inflammation of the inguinal and/or femoral lymph nodes. There may be prominent systemic symptoms of fever, chills, and malaise.

The third stage of disease is called the genito-anorectal syndrome. In women in particular, it may present after asymptomatic first and second stages. Patients initially present in the third stage with proctocolitis, followed by perirectal abscesses, strictures, fistulas, and rectal stenosis.


A55 – Chlamydial lymphogranuloma (venereum)

186946009 – Lymphogranuloma Venereum

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Differential Diagnosis & Pitfalls

  • Cellulitis / superinfected erosions
  • Mpox
  • Skin bacterial abscess
  • Herpes simplex virus (HSV) or Herpes zoster
  • Chancroid
  • Granuloma inguinale
  • Carcinoma – Cutaneous squamous cell carcinoma, Nodular basal cell carcinoma
  • Behçet syndrome
  • Primary syphilis
  • Fournier gangrene or Gas gangrene
  • Hidradenitis suppurativa
  • Pyoderma gangrenosum
  • Ecthyma gangrenosum
  • Inflammatory bowel disease – Crohn disease, Ulcerative colitis

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Last Reviewed:11/09/2021
Last Updated:09/04/2023
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Lymphogranuloma venereum
See also in: Cellulitis DDx,Anogenital
A medical illustration showing key findings of Lymphogranuloma venereum (Stage One (Male)) : Pustule, Skin ulcer, Smooth papule, Inguinal region
Clinical image of Lymphogranuloma venereum - imageId=419994. Click to open in gallery.  caption: 'A bubo, appearing as confluent crusted and scarred tumors in the inguinal area.'
A bubo, appearing as confluent crusted and scarred tumors in the inguinal area.
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