The incubation period is extremely variable ranging from 3 to 30 days. An herpetiform vesicle or papule develops at the site of infection. The vesicle ruptures and becomes a small painless punched-out ulcer which heals rapidly. The transient lesion may not be noticed. The primary lesion may take the form of a urethritis. In males, the primary lesion usually occurs on the penis. In females, the primary lesion usually develops on the vaginal wall or occasionally on the cervix and is rarely seen.

Up to 4 months later, unilateral or bilateral inguinal lymphadenopathy develops, often in association with headache, chills, sweats, weight loss, splenomegaly and migratory polyarthritis. Within 1 to 2 weeks, the nodes become tender and fluctuant and frequently ulcerate discharging purulent exudate. Buboes are more common in men. In women, deep iliac lymph nodes are usually involved.

In women, strictures of rectum and urethra and elephantiasis of the external genitalia (esthiomene) may develop. Rectal infections in homosexual men may progress from proctitis to rectal stricture.
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