Oropharyngeal Lymphogranuloma Venereum: A Clinical Reasoning Challenge and Literature Review

Lymphogranuloma venereum (LGV) is a sexually transmitted infection typically caused by serovars L1-L3 of Chlamydia trachomatis. These serovars are tissue-invasive with a preponderance for lymphatic spread and can be acquired via unprotected oral, anal, or vaginal sex. We present the case of a 23-year-old with a prior history of syphilis admitted with four weeks of progressively enlarging painful right cervical lymphadenopathy. Extensive testing, including oropharyngeal swabs and microbiological testing, did not yield a diagnosis, nor did extensive pathological and microbial testing of the lymph node biopsy tissue. Serological test of lymphogranuloma venereum revealed positive Chlamydia trachomatis L1 serovar antibodies. The patient had a complete resolution of his symptoms after three weeks of doxycycline therapy.