| Case number, date & clinic | Ethnicity & age (years) | Clinical presentation | Urethritis symptoms | HIV IgG status | Number of sexual contacts in last 3 months | Negative STI tests performed | LGV-specific PCR result | LGV serology | Treatment |
| 1* Dec 2003 STH | White British 54 | Tender unilateral 4 cm by 5 cm inguinal lymphadenopathy, subsequent ruptured bubo | Nil | Positive CD4 615 VL<50 | >5 | Urethral, rectal and pharyngeal GC cultureFVU CT SDARPR (past history of treated syphilis) | Positive (rectal biopsy specimen from subsequent LGV proctitis) | CGAb CFT negative (titre <20 in Feb 2005) | Doxycycline 100 mg twice daily for 3 weeks |
| 2 Sept 2005 C&W | White British 56 | 0.5 cm scrotal and perianal ulcers with subsequent unilateral inguinal lymphadenopathy and 4 cm by 3 cm bubo formation | Nil | Positive CD4 523 VL<50 | 1 | Urethral swab and rectal swab GC/CT (SDA)Urethral, rectal and pharyngeal GC cultureSyphilis EIA, TPPA, VDRL × 2HSV culture × 2 | Positive (scrotal ulcer swab and swab of fluid from ruptured bubo) | Psittacosis/LGV CFT negative (titres 1:20 twice, 2 weeks apart) | Doxycycline 100 mg twice daily for 17 days then azithromycin 1 g daily for 12 days then azithromycin 500 mg daily for 5 days |
| 3 Jan 2006 C&W | White British 46 | Penile ulcer and unilateral inguinal lymphadenopathy | Nil | Positive CD4 470 VL<50 | 10 | Urethral swab and rectal swab GC/CT (SDA)Urethral, rectal and pharyngeal GC cultureSyphilis EIAHSV culture | Positive (penile ulcer swab) | Not done | Doxycycline 100 mg twice daily for 3 weeks |
| 4 April 2006 STH | White British 61 | 0.7 cm painless solitary penile ulcer. No lymphadenopathy | Nil | Negative | 1 | FVU and rectal swab GC/CT (SDA)Rectal and pharyngeal GC cultureSyphilis IgM and RPR (past history of treated syphilis)HSV and Treponema pallidum PCR (in-house assay) from ulcer swab | Positive (penile ulcer swab) | Positive: CGAb titre 1:320 (STH); CGAb/LGV CFT titre 1:512 (HPA); CT WIF (L2 strain) titre 1:3000 (HPA, Bristol) | Doxycycline 100 mg twice daily for 3 weeks |
| 5 Dec 2006 STH | White Irish 24 | Bilateral inguinal buboes and preputial ulcer | Nil | Negative | 1 | Preputial ulcer swab darkground microscopySyphilis EIA (IgM and IgG)Rectal and pharyngeal GC cultureFVU GC/CT (SDA) and rectal swab GC (SDA)Rectal swab CT (SDA) indeterminate | Positive (bubo aspirate) | Positive CGAb CFT (titres 1:320 and 1:1280 2 weeks apart) | Doxycycline 100 mg twice daily for 3 weeks |
| 6 April 2007 STH | White British 34 | Bilateral tender 2 cm by 3 cm ruptured buboes | Nil | Positive CD4 787 VL<40 | 1 | Rectal and pharyngeal GC cultureUrethral swab GC/CT (SDA)Rectal swab GC/CT (SDA)Bubo pus bacterial and mycobacterial culturesSyphilis EIA | Positive (swab of bubo pus) | Not done | Doxycycline 100 mg twice daily for 3 weeks |
| 7 July 2007 MMC | White other 36 | Tender right 12 cm by 6 cm and left 4 cm by 2 cm inguinal lymphadenopathy | Nil | Negative | 4 | Rectal swab CT (PCR)Urethral, rectal and pharyngeal GC cultureSyphilis EIABubo aspirateUrethral smear <4 PMNLs/hpf | Positive (urethral swab PCR and chlamydial culture) | Positive CGAb (1:400) | Doxycycline 100 mg twice daily for 3 weeks |
| 8 Sept 2007 STH | Brazilian 21 | Bilateral tender inguinal lymphadenopathy | Dysuria | Negative | 1 | Rectal swab GC/CT (SDA)Urethral, rectal, and pharyngeal GC cultureSyphilis EIAUrethral smear <4 PMNLs/hpf | Positive (FVU and lymph node aspirate) | Not done | Doxycycline 100 mg twice daily for 3 weeks |
| 9 Sept 2007 STH | British Indian 35 | Tender 3 cm by 2 cm unilateral inguinal lymphadenopathy | Nil | Negative | 2 | Rectal swab GC/CT (SDA)Urethral, rectal, and pharyngeal GC cultureSyphilis EIAUrethral smear 5–10 PMNLs/hpfFVU specimen was CT positive (SDA) but specimen was discarded prior to typing | Positive (lymph node aspirate) | Not done | Flucloxacillin for 1 week (prior to diagnosis) Doxycycline 100 mg twice daily for 3 weeks |
| 10 Nov 2007 MMC | White British 36 | Tender 4 cm by 4 cm unilateral inguinal lymphadenopathy | Nil | Negative | 1 | Urethral and pharyngeal GC cultureSyphilis EIA | Positive (urethral swab) | Not done | Azithromycin 1 g weekly for 3 weeks |
| 11 April 2008 STH | White Dutch 37 | Non-tender 2 cm by 3 cm unilateral inguinal lymphadenopathy | Nil | Positive CD4 519 VL 35814 | 15 | FVU and rectal swab GC/CT (SDA)Rectal and pharyngeal GC culture | Positive (lymph node aspirate) | Not done | Doxycycline 100 mg twice daily for 3 weeks |
| 12 May 2008 STH | Argentinean 35 | Painful 5 cm by 3 cm unilateral inguinal lymphadenopathy | Nil | Negative | 5 | Urethral and pharyngeal GC cultureRectal swab and lymph node aspirate GC/CT (SDA)Urethral smear 10–20 PMNLs/hpf | Positive (urethral swab and FVU) | Not done | Doxycycline 100 mg twice daily for 3 weeks |
| 13 July 2008 STH | White British 34 | Painful single 1 cm penile subpreputial ulcer, subsequent tender unilateral inguinal lymphadenopathy and tender 1 cm dorsal penile bubonulus formation with penile lymphoedema | Nil | Positive CD4 341 VL 27047 | 2 | Penile ulcer swab darkground microscopy and HSV PCRSyphilis EIA IgM and RPR (past history of treated syphilis)Rectal and pharyngeal GC cultureFVU GC/CT (SDA) and rectal swab CT (SDA)FVU CT (SDA) equivocalRectal swab GC (SDA) detected | Positive (lymph node aspirate) | Not done | Doxycycline 100 mg twice daily for 3 weeks |
CFT, complement fixation test; CGAb, chlamydia group antibody; CT, Chlamydia trachomatis; C&W, Chelsea and Westminster; EIA, enzyme immunoassay; FVU, first void urine; GC, Neisseria gonorrhoeae; HPA, Health Protection Agency; HSV, herpes simplex virus; MMC, Mortimer Market Centre; PCR, polymerase chain reaction; PMNLs/hpf, polymorphonuclear leucocytes per high power field (x100); RPR, rapid plasma reagin; STH, St Thomas’ Hospital; SDA, strand displacement amplification; TPPA, Treponema pallidum particle agglutination; VDRL, Venereal Disease Research Laboratory; VL, viral load; WIF, whole immunofluorescence.