A 35 year old sailor from a merchant ship that has been cruising the Caribbean presents to a clinician because of painful, flocculent masses in his groin. Physical examination demonstrates multiple enlarged, abscessed lymph nodes draining through the skin indolent sinuses. The sailor describes previously having a small papular lesion on his penis that spontaneously resolved. Which of the following is the most likely diagnosis?

This is lymphogranuloma venereum. The only other commonly discussed sexually transmitted disease in which they can occur is chancroid. Histologically, the buboes of lymphogranuloma venereum are enlarged lymph nodes with stellate abscesses. The primary lesion is usually a self-healing papule or shallow ulcer. The causative organism is Chlamydia trachomatis. Condyloma acuminatum causes a papillary lesion and does not cause buboes. Granuloma inguinale causes a spreading ulcer and does not cause buboes. Herpes virus infection causes tiny vesicles and ulcers and does not cause buboes. Ref: Brooks G.F., Carroll K.C., Butel J.S., Morse S.A., Mietzner T.A. (2013). Chapter 27. Chlamydia Spp.. In G.F. Brooks, K.C. Carroll, J.S. Butel, S.A. Morse, T.A. Mietzner (Eds), Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e.