Who is at risk for lymphogranuloma venerum (LVG) proctitis and what is a typical presentation?

The Bottom Line:  Risk factors include having large numbers of sexual partners and high rates of unprotected anal sex.  Purulent anorectal discharge, pain and bleeding typify LGV proctitis symptoms and occur in most proctitis cases. Tenesmus and constipation, while less frequent, when seen with proctitis seem to be more specific for LGV compared with other rectal STIs.
Summary: The clinical features of classical LGV have been well described and are usually divided into three stages: primary (usually a genital ulcer, often transient and unnoticed), secondary (inguinal adenitis, bubo formation; heterosexual haemorrhagic proctitis) and tertiary (chronic granulomatous inflammation, lymphoedema, elephantiasis; rectal stricture; often irreversible).  LGV has reemerged among MSM in cities of the developed world, causing severe proctitis as well as ulcer-adenopathy syndrome. C. trachomatis serovar L2b appears to have reestablished endemicity within this population and may also be contributing to the epidemics of HIV and HCV by facilitating transmission.
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