In women, it is usually found in the posterior wall of the vagina, vulva or cervix. The secondary stage appears in two main settings. Swelling of the inguinal lymph nodes is the presentation in the inguinal syndrome which are more common in men. It has an incubation period of 10 to 30 days. The nodes are firm, slightly painful and enlarge over 1 to 2 weeks and are unilateral in two third of the cases.
Constitutional symptoms are common and associated with the systemic spread of the chlamydia.
However spontaneous recovery occurs in a great majority of the cases. In women, inguinal lymphadenitis is unusual, however, the iliac lymph nodes may be involved and lead to pelvic adhesions. When this occurs the patient may complain of lower abdominal pain made worse when lying supine. The anorectal syndrome is a more common presentation in women and homosexual male who practise anal intercourse. They may complain of anal pruritis, rectal pain and tenesmus.