Lymphogranuloma venereum physical examination

Primary LGV is characterized by a small, nontender papule or ulcer. The primary lesion is typically unnoticed so few patients present at this stage. Majority of patients that do present are male. Secondary LGV is characterized by tender, swollen lymph nodes, typically unilateral, known as buboes. Enlarged inguinal and/or femoral lymph nodes occur after primary lesion of anterior genital area. Enlarged iliac and/or perirectal lymph nodes occure after primary lesion of posterior genital area. 20% of patients present with “groove sign”. Buboes may be indurated or draining sinuses. Tertiary LGV is characterized by [perirectal]] fistulas and/or strictures, ulcerative proctitis, and/or Elephantiasis of gentials. Males may present with “saxophone penis“. Females may present with with ulceration and thickening of the vulva.

• Fever during later stages

• Patients presenting at first stage of LGV usually have a small, nontender papule or ulcer.^[1]
• Common locations in males:

• Coronal sulcus
• Prepuce
• Glans
• Scrotum

• Common locations in females:

• Posterior vaginal wall
• Posterior cervix
• Fourchette
• Vulva

• Due to lesion location on each sex, more males present at this stage than females.^[1]

• Patients present with tender, swollen lymph nodes, typically unilateral, known as buboes.

• Enlarged inguinal and/or femoral lymph nodes occur after primary lesion of anterior genital area (anterior vulva, penis, or urethra).
• Enlarged iliac and/or perirectal lymph nodes occure after primary lesion of posterior genital area (posterior vulva, vagina, or anus).
• Inguinal inflammation more common in men while anorectal lymphadenopathy more common in women

• 20% of patients develop “groove sign”: enlarged inguinal and femoral lymph nodes separated by the inguinal ligament.^[2]
• Buboes may present as indurated abscesses or ruptured, draining sinuses.^[3]

• Patients present with perirectal fistulas and/or strictures
• Patients presenting at this stage are predominantly female or homosexual males
• Proctoscopy may reveal ulcerative proctitis^[4]
• Elephantiasis of gentials
• Ulceration and thickening of the vulva in females
• Penile and scrotal edema termed “saxophone penis“^[5]

• 
  Lymphogranuloma venereum: is caused by the invasive serovars L1, L2, or L3 of Chlamydia trachomatis. This young adult experienced the acute onset of tender, enlarged lymph nodes in both groins.

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