Answer

Ulcers

A 23 year old prostitute comes into the gynecological office for superficial ulcers on her labia majora. These ulcers are painless.

Laboratory: Cytoplasmic inclusions of obligate intracellular organisms seen with Giemsa stain and immunoflourescence.

Discussion: Diagnosis of Lymphogranuloma venereum by Chlamydia trachomatis (L1, L2, L3) is made by labs and clinical presentation. Three of fifteen known strains of C. trachomatis described as serovars L1, L2, and L3 are responsible for Lymphogranuloma venereum (LGV). While the strains of Chlamydia that cause urethritis appear to infect only squamocolumnar cells, LGV strains are more invasive and capable of replication in macrophages.