The onset of the second stage occurs 2-6 weeks later and often manifests as unilateral inguinal lymphadenopathy. The third stage may occur years after the initial infection and is known as the genitoanorectal syndrome. However, true incidence of the disease is believed to be 400-600 cases per year. However, progression to the third stage of the disease can result in serious and sometimes permanent sequelae such as genital deformity, fistulas, and rectal strictures. Death is rare but may be caused by complete bowel obstruction and perforation due to a rectal stricture.
Men are more likely to present with inguinal lymphadenopathy in the second stage of the disease.
Women and homosexuals who engage in receptive anal intercourse are more likely to present with complications of late disease. The primary stage is characterized by a transient, nonpainful lesion that usually goes unnoticed by the patient. Therefore, it is rare for a patient to present with this early stage of the disease. Travel and sexual history is important due to the fact that LGV often is seen in people who have been sexually active in areas where the disease is endemic. Male patients tend to present in the second stage with painful inguinal lymphadenopathy that usually is unilateral.