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LGV Bubo Management — SCE Infectious Diseases MCQ

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HardSTIsLGV Bubo ManagementSCE Infectious Diseases

A 28-year-old man presents with a 3-day history of painful inguinal lymphadenopathy, fever, and a small healing genital ulcer. He recently returned from South-East Asia. The inguinal bubo is fluctuant. HSV PCR from the ulcer is negative. Syphilis serology is negative. Chlamydia trachomatis NAAT from the ulcer is positive, and LGV typing confirms serovar L2. In addition to Doxycycline 100 mg BD for 21 days, what is the correct management of the bubo?

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Correct answer: D — Needle aspiration through intact overlying skin — incision and drainage is specifically contraindicated

Explanation lettering: C = shown as A · D = shown as C · E = shown as D · A = shown as E

Fluctuant inguinal buboes in LGV must be aspirated through INTACT overlying skin to prevent chronic sinus formation. Incision and drainage is specifically contraindicated because it creates persistent draining sinuses that are difficult to manage. Aspiration may need to be repeated if the bubo reaccumulates. This is a critical management point unique to LGV that distinguishes it from other causes of inguinal lymphadenopathy where I&D may be appropriate.

Reference: BASHH 2019 – LGV guidelines; WHO 2024 – STI treatment