Lymphogranuloma venereum is a sexually transmitted disease caused by Chlamydia trachomatis serovars L1-L3. It initially presents as a small painless skin lesion at the site of inoculation, followed by swelling of local lymph nodes known as buboes. If left untreated, it can spread and cause complications affecting the genital, anal, and rectal regions including ulcers, scarring, and fistulae formation. Diagnosis involves microscopy, culture, PCR or serology of infected lymph node aspirates or lesions. Treatment is with doxycycline or azithromycin over 3 weeks along with treatment of sexual partners.

1. LYMPHOGRANULOMA
VENEREUM

2. Synonyms
Tropical or Climatic bubo
Durand-Nicholas-Favre disease
Lymphogranuloma inguinale
Poradenitis inguinalis
Strumous bubo

3. History
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Walkee in 1833 first identified
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Caddy 1902 “Climatic bubo” India
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Durand-Nicolas-Favre 1913 “LGI”
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Frei 1925 – Intradermal Test
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1927  Chlamydia Trachomatis causal agent

4. DEFINITION
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Sexually transmitted disease
A disease affecting the Lymphatic System
Caused by Chlamydia Trachomatis Serovars
L1-L2-L3
Regional Suppurative LAN preceded by a
small transient inconspicuous lesion at
Inoculation Site

5. EPIDEMIOLOGY
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6% Prevalence Rate in Clinics
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Endemic to India
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20 - 40 yrs.
•
Male : female = 5 :1
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Urban, sexual promiscuity, low socio- economic
status.

6. AETIOLOGY
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Chlamydia Biovar LGV Serovar L1/L2/L3
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Obligate intracellular, Gram negative bacillus with
humans as Natural Hosts by Sexual Transmission /
Perinatal infection
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Intracytoplasmic inclusion bodies
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Controls the organelles of host cells for own growth
and protein synth
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Cell cycle – 48 to 72 hrs

7. 
sss

8. PATHOGENESIS
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Entry into cell as Metabolically inactive
elementary body (Eb) by receptor mediated
endocytosis.
Conversion to Active Reticulate Bodies which
multiply , condense and form Eb  burst out of
host cells
Lymphangitis, perilymphangitis, necrosis of
lymph nodes
PMN stellate abscess- bubo
Healing by fibrosis - esthiomene, adhesions
Dissemination rare

9. 
sas

10. CLINICAL FEATURES
Primary stage
Incubation period : 3-12 days.
Single, painless, evanescent, inconspicuous
Papule / vesicle / Erosion / Ulcer ?herpetiform
Male – coronal sulcus, prepuce, glans,
urethra
Female - endocervix, post vaginal wall
Oral / Rectal localization
NSU
BUBONULUS – Lymphangitic nodules over
dorsal penis  Chord-like swelling

11. PRIMARY LESION

12. BUBONULUS

13. Secondary ‘INGUINAL’ stage
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02-06 wk after primary lesion
Inflammatory swelling of Inguinal nodes in males
perirectal and iliac nodes in females  ‘BUBOES’ 
Fluctuant if untreated  Multilocular Suppuration (70%)
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Unilateral 2/3rd cases
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Constitutional symptoms with bubo
Blue ball sign / Livid colour of overlying skin over
Bubo predicts rupture
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Groove sign of Greenblat (20%)

14. GROOVE’S SIGN

15. ‘BLUE-BALL’ SIGN

16. SECONDARY STAGE
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‘Stage of Diagnosis’
? Women
Dissemination (Rare, hematogenous)
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Arthritis
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Ocular inflammatory disease
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Pneumonitis
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Hepatitis
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EN / EM

17. TERTIARY STAGE
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Develops in 25% of untreated
GENITO-ANO-RECTAL syndrome, more common in
women / MSM
Clinical features
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Hyperplastic Ulcerative lesions
Proctocolitis
• Bloody purulent discharge
• Pruritis Ani
• Tenessemus

18. TERTIARY STAGE
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Lymphatic tissue hyperplasia (LYMPHORROIDS /
PERI-ANAL CONDYLOMAS)
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Chronic Ulceration / Scarring
Fistulae / Strictures
Mechanisms
Peno-Anal Intercourse
Posterior Urethral spread
Direct Spread from Vaginal Secretions
Lymphatic Dissemination by Cx

19. PROCTO-COLITIS

20. COMPLICATIONS
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Genital Elephantiasis
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Ram-rod / Ram-horn / Saxophone Penis

21. COMPLICATIONS
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ESTHIOMENE / Vulval Elephantiasis

22. COMPLICATIONS
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CA RECTUM (2-5%)
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EPIDIDYMO-ORCHITIS
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PROSTATITIS
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SEMINAL VESICULITIS

23. Extragenital manifestations
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Ocular manifestations
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Can occur at any stage
common with L2
Conjunctivitis, Episcleritis, Keratitis, Iritis
Submaxillary, post auricular LN
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Cutaneous manifestations
Id eruptions
Ilio-Psoas Abscess

24. Differential diagnosis
Primary stage
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Genital herpes
Primary syphilis
Chancroid
Traumatic ulcer
NGU
Secondary stage
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Chancroid
Syphilis
Genital herpes
Bubonic Plague
Tuberculosis
Septic LAN

25. Investigations
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Leucocytosis
Raised ESR
Hyperproteinemia with raised globulin
False positive VDRL
Microscopy with giemsa stain
Frei’s test

26. Investigations
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Microscopy / Identification
Gram stain, Giemsa stain, Warthin Starry, Machiavello
Isolation
Culture on McCoy / HeLa Cell Line (Brown Inclusion
bodies)
Histopathology – Stellate Abscesses / Gran Infiltrate
Serological tests: CFT, PCR, NAAT,
IMMUNOFLUORESCENCE
CT / MRI, Lymphography

27. Management
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General measures
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Medical Cap Doxycycline 100 mg bd
Tab Erythromycin 500 mg qid
Tab Azithro 1gm/wk

21days
Erythromycin 7.5- 12.5 mg/kg qid for 2-3wk for
children and pregnant patients

28. 
Surgical
Bubo aspiration preferred over I & D
Sx - elephantiasis, esthiomene, sinus,
fistulae,
stricture dilatation
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Partner management (All contacts in 60
days)
azithromycin 1 gm orally single dose or
doxycycline 100 mg BD X 07 days