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In men
The initial vesicular or ulcerative lesion (on the external genitalia) is evanescent and often goes unnoticed
Inguinal buboes appear 1–4 weeks after exposure, are often bilateral, and have a tendency to fuse, soften, and break down to form multiple draining sinuses, with extensive scarring
In women
Late manifestations
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The complement fixation test may be positive (titers > 1:64), but cross-reaction with other chlamydiae occurs
Nucleic acid detection tests are sensitive, but not FDA-approved for rectal specimens and cannot differentiate lymphogranuloma venereum (LGV) from non-LGV strains
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Doxycycline, 100 mg twice daily orally for 21 days; contraindicated in pregnancy
Erythromycin, 500 mg four times daily orally for 21 days
Azithromycin, 1 g orally once weekly for 3 weeks, may also be effective