Lymphogranuloma venereum - Anogenital in
See also in: Overview,Cellulitis DDxAlerts and Notices
Synopsis
There are 3 distinct stages in the course of the disease.
Stage 1:
After a 3- to 30-day incubation period, a small, painless papule or pustule develops on the genital area. Most often, it will erode and ulcerate. This lesion is often asymptomatic and heals without scarring within 1 week. Some patients may be unaware of this occurrence.
Stage 2:
The second or inguinal stage begins 2-6 weeks after the primary lesion. It signifies the spread of the organism from the primary lesion into the lymph nodes and presents as inguinal buboes (painful inflammation of the inguinal lymph nodes), which become fluctuant and rupture. Symptoms include general weakness, headache, and weight loss. It is usually during this stage that patients seek medical help.
Stage 3:
The third stage of LGV is elephantiasis of the penis and scrotum. This swelling is caused by fibrosis with occlusion of the lymphatics, which impedes lymphatic return. Genito-anorectal syndrome can also be seen in the third stage, but usually only in men who have sex with men or in women. These patients initially present with proctocolitis, followed by perirectal abscesses, strictures, fistulas, and rectal stenosis.
Codes
ICD10CM:A55 – Chlamydial lymphogranuloma (venereum)
SNOMEDCT:
186946009 – Lymphogranuloma Venereum
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Cellulitis / superinfected erosions
- Monkeypox
- Abscess
- Herpes simplex virus (HSV) or herpes zoster
- Chancroid
- Granuloma inguinale
- Carcinoma – squamous cell, basal cell, etc
- Behçet disease
- Syphilis
- Fournier or gas gangrene
- Hidradenitis suppurativa
- Pyoderma gangrenosum
- Ecthyma gangrenosum
- Bubonic plague
- Tuberculosis
- Tularemia
- Inflammatory bowel disease – Crohn disease, ulcerative colitis
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Therapy
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References
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Last Reviewed:11/09/2021
Last Updated:07/07/2022
Last Updated:07/07/2022
Lymphogranuloma venereum - Anogenital in
See also in: Overview,Cellulitis DDx