Diagnostic delays and persistent symptoms in lymphogranuloma venereum among men who have sex with men in Poland: a single-centre case series.

BACKGROUND

Lymphogranuloma venereum (LGV) caused by Chlamydia trachomatis serovars L1-L3 is increasingly reported among men who have sex with men (MSM) in Western Europe, yet appears to remain underrecognised in Central and Eastern Europe. We describe clinical characteristics, diagnostic pathways, and outcomes of LGV cases in Poland to highlight recognition barriers and public health implications.

METHODS

We conducted a retrospective case series of symptomatic MSM diagnosed with LGV at a dermatovenereology outpatient clinic in Gdańsk, Poland, between 1 December 2023 and 31 October 2025. Cases were confirmed by C. trachomatis nucleic acid amplification test followed by LGV-discriminatory PCR. We extracted demographic, clinical, laboratory, and treatment data from electronic records.

RESULTS

Seven MSM (median age 28 years, range 25-68) were diagnosed with LGV; five (71%) were living with HIV. Common symptoms included rectal bleeding, rectal pain, and mucopurulent discharge (each 71%). Median time from symptom onset to diagnosis was 6 months (range 2 weeks-7 months); patients consulted a median of 3 physicians (range 1-5) before diagnosis. Five underwent colonoscopy with findings initially suggesting inflammatory bowel disease or malignancy. Concurrent sexually transmitted infections were frequent, including gonorrhoea (57%), syphilis (29%), and herpes simplex virus (29%). All received doxycycline 100 mg twice daily for 21 days. Three patients-all with diagnostic delays ≥ 6 months-reported persistent anorectal symptoms post-treatment despite microbiological cure.

CONCLUSIONS

LGV may be underdiagnosed in Poland, and diagnostic delays exceeding six months may be associated with persistent symptoms despite microbiological cure. Enhanced clinician awareness, routine sexual history-taking in both primary and specialist care, and improved access to LGV-discriminatory testing are needed to reduce morbidity and prevent irreversible complications in this vulnerable population.