This sign is caused by enlargement of the nodes above and below the inguinal ligament. One third of these inguinal buboes become fluctuant and rupture, while the remaining two thirds involute to form a hard, nonsuppurative inguinal mass. Women often have primary involvement of the rectum, vagina, cervix, or posterior urethra, which drain to the deep iliac or perirectal nodes. Chronic infection can lead to extensive scarring with ischemia and tissue necrosis. The best results have been obtained using aspirates from an involved inguinal lymph node and bacterial typing of the culture after growth.
Serologic tests are also available and produce a strong reaction by compliment fixation.
The difficulty is in separating the various serotypes of Chlamydia species including those involved in conjunctivitis. Antibody titers do not correlate well with the clinical severity of the disease. The usefulness of these methods is limited by their availability. As with all STDs, consider concomitant infections and perform screening tests. Necessary procedures may include aspiration of buboes to speed healing and relieve discomfort.