Sex Transm Infect 79:453-455 doi:10.1136/sti.79.6.453

Unusual presentation of early lymphogranuloma venereum in an HIV-1 infected patient: effective treatment with 1 g azithromycin

  1. R F Nieuwenhuis1,
  2. J M Ossewaarde2,
  3. W I van der Meijden1,
  4. H A M Neumann1
  1. 1Department of Dermatology and Venereology, Erasmus MC, Dr Molewaterplein 40, 3015 GD Rotterdam, Netherlands
  2. 2Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Dr Molewaterplein 40, 3015 GD Rotterdam, Netherlands
  1. Correspondence to:
 Dr W I van der Meijden
 Department of Dermatology and Venereology, Postbus 2040, 3015 GD Rotterdam, Netherlands;
  • Accepted 21 July 2003


The incidence of lymphogranuloma venereum (LGV) is low in the western world. Early LGV is characterised by bubonic disease following a painless papule or small ulcer. We report a white bisexual male who presented with a painful perianal ulcer, inguinal lymphadenitis, and concomitant infection with human immunodeficiency virus 1 (HIV-1). Chlamydia trachomatis serovar L2 was identified as the cause after polymerase chain reaction and genotyping the major outer membrane protein by restricted fragment length polymorphism. Treatment with a single dose of 1 g azithromycin was effective. This case illustrates that early LGV may mimic other genital ulcer diseases, such as genital herpes or chancroid, especially in HIV infected patients. In the western world, LGV must still be included in the differential diagnosis of bubonic disease with or without sexually acquired ulcers.