QuestionSBA
QuestionChoice
The most likely diagnosis is lymphogranuloma venerum (LGV). This is a sexually transmitted infection that is caused by specific serovars of Chlamydia trachomatis. The primary infection of infection is characterised by painless genital ulceration. The secondary stage follows weeks later with painful, inguinal and/or femoral lymphadenopathy (buboes). The first-line treatment option is with a three-week course of doxycycline
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Doxycycline
QuestionChoice
This is the first-line treatment for syphilis. Although primary syphilis presents with a painless genital ulcer, secondary syphilis would present differently with features such as a maculopapular rash, generalised lymphadenopathy and constitutional symptoms
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b
IM benzathine penicillin
QuestionChoice
Aciclovir can be used for recurrent cases of genital herpes which is caused by Herpes simplex virus. Genital herpes would present with painful genital ulceration and it is not associated with buboes
32501
d
Oral aciclovir
QuestionChoice
Conservative management would be the first-line treatment for genital herpes. Genital herpes would present with painful genital ulceration and it is not associated with buboes
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e
Conservative management with analgesia
QuestionChoice
Ceftriaxone is the first-line treatment for uncomplicated, anogenital gonorrhoea. The clinical vignette is suggestive of LGV which is caused by Chlamydia species
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c
IM ceftriaxone
QuestionComment
Would have been nice if stem mentioned whether lymphadenopathy is tender or not
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Tanoy Kinase
QuestionComment
Doesn't mention painful lymphadenopathy at all. This could be syphilis? 
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Myotonia Bladder
QuestionComment
stem did not mention pain. pain = LGV, painless = syphilis 
16606
QuestionComment
painless ulcer but painful lymphadenopathy in LGV*
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Axillary Stasis
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Spiderpig747
QuestionComment
My thoughts are if the majority of people get the answer wrong it's probably a vague question that would be taken out of the exam anyway so I am not gonna sweat it 
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Gastro Flutter
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Is LGV bilateral a reason for it being answer 
24429
QuestionComment
I thought LGV would usually be unilateral?
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Acute Body
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Serpiginous Zika
QuestionComment
Is the ans LGV because picture is showing 'groove sign'? 
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anon
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This question came up on full screen whilst I was sat in a coffee shop. Can't imagine what the other people must've thought
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Axillary RNA
Concept
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# Summary


Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by specific serovars (L1, L2, or L3) of *Chlamydia trachomatis*. Characterised by painless genital ulcers and inguinal lymphadenopathy, LGV is more common in men who have sex with men. Its diagnosis is mainly based on molecular techniques, like PCR, to detect *C. trachomatis* from a swab of the ulcer. Management involves a 21-day course of antibiotics, including doxycycline, tetracycline, or erythromycin. 


# Definition


Lymphogranuloma venereum (LGV) is a sexually transmitted infection (STI) predominantly caused by the L1, L2, or L3 serovars of *Chlamydia trachomatis*.


# Epidemiology


LGV is more frequently observed in men who have sex with men (MSM). HIV infection is also a risk factor.


# Aetiology


The aetiology of LGV involves infection with the L1, L2, or L3 serovars of *Chlamydia trachomatis*, typically through sexual contact.


# Signs and Symptoms


- Painless genital ulcer
- Typically appears 3-12 days after infection
- It might go unnoticed, particularly if it occurs inside the vagina
- Inguinal lymphadenopathy, often noticeable
- Proctitis, associated with rectal pain and discharge (in case of rectal infections)
- Systemic symptoms can include fever and malaise


# Differential Diagnosis 


- **Primary syphilis**: Presents with a solitary, painless genital ulcer (chancre) and regional lymphadenopathy.
- **Herpes simplex virus infection**: Characterised by multiple painful vesicles or ulcers, systemic symptoms, and occasional inguinal lymphadenopathy.
- **Chancroid**: Caused by *Haemophilus ducreyi*, it presents with painful genital ulcers and painful inguinal lymphadenopathy.


# Investigations


Molecular diagnostic techniques, such as polymerase chain reaction (PCR), are used to detect *C. trachomatis* from a swab of the genital ulcer.

It is also important to screen for other sexually transmitted infections and blood-borne infections such as HIV.


# Management


The standard treatment for LGV involves antibiotics. Common regimes include:


- Oral doxycycline: 100 mg administered twice daily for 21 days
- Oral tetracycline: 2 g administered daily for 21 days
- Oral erythromycin: 500 mg given four times daily for 21 days


# References


[BASHH guidelines: Lymphogranuloma venereum](https://www.bashhguidelines.org/media/1054/2013-lgv-guideline.pdf)
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Picture
Swollen inguinal lymph nodes in someone with lymphogranuloma venereum.
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Lymphogranuloma venereum ulceration.
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Lymphogranuloma Venereum
Topic
27
Genitourinary medicine
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Lymphogranuloma venereum, a sexually transmitted infection caused by Chlamydia trachomatis, is managed with doxycycline 100 mg twice daily for 21 days to eliminate the infection and prevent complications.
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Topic
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Genitourinary medicine
A 24-year-old homosexual male presents with a two-week history of enlarging lumps in both sides of his groin. He reports noticing a painless penile ulcer around three weeks ago that resolved spontaneously.

He denies any other symptoms on questioning but reports having had multiple sexual partners over the last three months.

Examination of his groin is significant for the findings shown in the image below.

[lightgallery]

Given the likely diagnosis, which of the following is the most appropriate treatment option?
a