A 19-year-old woman presents to the student health clinic with concern about a lesion in her genital region which she noticed 3 days ago. She is sexually active with multiple partners and takes a daily oral contraceptive pill. She does not use barrier protection. Past medical history is unremarkable. Careful workup indicates that she has contracted a sexually transmitted infection (STI) caused by an intracellular organism that is poorly gram staining.
D) Painless genital ulcer without inguinal lymphadenopathy
This patient is presenting in the early stage of lymphogranuloma venereum (LGV), caused by Chlamydia trachomatis serotypes L1-L3. Bilateral inguinal lymphadenopathy will develop after the ulcer has disappeared. LGV is associated with newly diagnosed HIV infection as well as other STIs, so this patient should have screening for other STIs.
Answer choice A: Grouped painful genital vesicles with fever and arthralgia, is incorrect. This describes the lesions of herpes genitalis, caused by herpes simplex virus types 2 (most common) and 1.
Answer choice B: Painful genital ulcer with unilateral inguinal lymphadenopathy, is incorrect. This describes the STI chancroid, caused by Haemophilus ducreyi. This organism is gram negative and classically appears in a “school of fish” arrangement on microscopy.
Answer choice C: Painless genital ulcer with bilateral inguinal lymphadenopathy, is incorrect. This is the typical presentation of primary syphilis, caused by the spirochete Treponema pallidum.
Answer choice E: Painless inguinal ulcer that bleeds upon contact, is incorrect. This describes granuloma inguinale, also known as Donovanosis, which is caused by Klebsiella granulomatis. This is uncommon in the United States.
Key Learning Point
Lymphogranuloma venereum (LGV) is caused by the intracellular organism Chlamydia trachomatis and presents initially with a painless genital ulcer, which typically resolves before development of bilateral inguinal lymphadenopathy.
