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Lymphogranuloma venereum presenting as genital ulceration and inguinal syndrome

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To the Editor: Diagnoses of lymphogranuloma venereum (LGV; caused by the L1–L3 serovars of Chlamydia trachomatis) worldwide have increased dramatically among men who have sex with men over the past 8 years. In New South Wales, 35 cases were diagnosed in 2011, compared with 2–3 per year before 2008.1

Traditionally, LGV is described as causing a primary ulcerative genital lesion 3–30 days after exposure, leading to a secondary inguinal syndrome of buboes, which may rupture, and constitutional symptoms.2 However, this appears to be uncommon among current cases; the overwhelming majority of patients present with proctitis.3 Untreated, LGV can lead to genital scarring and anorectal strictures.

Recently, a 37-year-old HIV-positive man with a history of treated syphilis presented to our clinic with a 1-week history of a small painless indurated penile ulcer. He reported unprotected insertive anal sex 2 weeks previously with an HIV-positive casual male partner.

Tests for herpes simplex virus and polymerase chain reaction (PCR) testing for Treponema pallidum were negative. Urine testing and rectal and pharyngeal swabs were…