Oropharyngeal lymphogranuloma venereum caused by Chlamydia trachomatis genovariant L2b in men who have sex with men in Taiwan

Lymphogranuloma venereum (LGV) caused by Chlamydia trachomatis (CT) serovars L1-L3 has re-emerged among men who have sex with men (MSM), predominantly manifesting as anorectal disease. Oropharyngeal LGV remains poorly characterized, with only sporadic case reports in Western countries. Although CT genovariant L2b has been detected in an oropharyngeal specimen through surveillance in Taiwan, the clinical features of oropharyngeal LGV have not been described in Asia. We report two MSM living with HIV in Taiwan with oropharyngeal LGV. Case 1 was a 32-year-old asymptomatic patient and CT was identified through routine multi-site screening prompted by a rising rapid plasma reagin (RPR) titer. LGV was detected only at the oropharyngeal site, with a negative rectal specimen. Case 2, a 51-year-old man, presented with small oral ulcers resembling aphthous stomatitis, along with anorectal symptoms and amoebic liver abscess. Genovariant L2b was confirmed in both oropharyngeal and rectal specimens by ompA sequencing. In both cases, Treponema pallidum PCR on oropharyngeal specimens was negative despite elevated RPR titers. Case 1 received doxycycline 100 mg twice daily for 7 days for asymptomatic LGV carriage, while Case 2 received a 21-days course for symptomatic infection. Case 1 achieved microbiological cure confirmed by follow-up PCR testing. Case 2 demonstrated resolution of oral and anorectal symptoms, with microbiological cure confirmed at follow-up. These cases illustrate that oropharyngeal LGV may be asymptomatic or mimic common oral conditions. Multi-site CT testing and ompA genotyping should be considered in MSM with suspected STI, even in the absence of typical anorectal symptoms.