A 39-year-old homosexual man complained about moderate perianal itching and fairly persistent anal discharge. He is HIV-positive but reliably takes his antiretroviral medications. His complaints did not respond to a course of oral fluconazole.
Key points: Physical examination disclosed some mild perianal erythema and a serous discharge. This does not appear to be very serious. However, when a specimen was submitted to the CDC for analysis, it was found to be positive for Chlamydia trachomatis, serovar L2b. This recently discovered microbe causes atypical lymphogranuloma venereum (LGV), primarily in gay Caucasian men over age 35. LGV, resurgent in industrialized countries, presents in this manner.
Treatment: Symptoms and discharge resolved after a 2-week oral course of doxycycline, in a dosage of 100 mg, twice daily.
Note: This scenario is also often complicated by known or occult infection with hepatitis C virus. Always check for this form of hepatitis in such patients.