Anal infections with concomitant Chlamydia trachomatisgenotypes among men who have sex with men in Amsterdam, the Netherlands

Abstract

BackgroundLymphogranuloma venereum (LGV) proctitis is caused by Chlamydia trachomatis (Ct) genotype L and is endemic among men who have sex with men (MSM) in western society. Genotype L infections need to be distinguished from non-LGV (genotypes A-K) Ct infections since they require prolonged antibiotic treatment. For this purpose, an in-house developed pmpH based LGV polymerase chain reaction (PCR) test is used at the Amsterdam STI outpatient clinic. We investigated retrospectively the anal Ct genotype distribution, and the frequency of concomitant genotype infections in MSM infected with LGV and non-LGV Ct infections. To detect concomitant Ct genotype infections, the pmpH LGV PCR and genoTyping Reverse Hybridization Assay (Ct-DT RHA) were used.MethodsA total of 201 Ct positive rectal swabs from MSM were selected, which were previously diagnosed as either LGV (n = 99) or non-LGV Ct infection (n = 102) according to the algorithm of Ct detection by the commercially available Aptima Combo 2 assay followed by an in-house pmpH LGV PCR. The samples were retested with the commercially available Ct-DT RHA, which differentiates between 14 major genotypes and is able to detect concomitant Ct genotypes.ResultsExcellent genotyping agreement was observed between the Ct-DT RHA and the pmpH LGV PCR (Kappa = 0.900, 95%CI = 0.845-0.955, McNemar's p = 1.000). A concomitant non-LGV genotype was detected in 6/99 (6.1%) LGV samples. No additional LGV infections were observed with the Ct-DT RHA among the non-LGV Ct group. In the non-LGV group genotype G/Ga (34.3%) was seen most frequent, followed by genotype D/Da (22.5%) and genotype J (13.7%). All LGV infections were caused by genotype L2.ConclusionsConcomitant non-LGV genotypes do not lead to missed LGV proctitis diagnosis. The pmpH LGV PCR displayed excellent agreement with the commercially available Ct-DT genotyping RHA test. The genotypes G/Ga, D/Da and J were the most frequent non-LGV Ct strains in MSM.

Difference in Distribution of Chlamydia trachomatis Genotypes among Different Provinces: a Pilot Study from Four Provinces in China

“…In this study, genovar G/Ga was found to be endemic among male patients from southern China, which is consistent with the C. trachomatis genovar distribution patterns found in populations of men who have sex with men (MSM) in China (8), Australia (17), and the Netherlands (18). An earlier study has shown that polymorphisms of the open reading frames of the ompA gene were strongly associated with rectal tropism in serovar G isolates (19).…”

Chlamydia trachomatis Strains Show Specific Clustering for Men Who Have Sex with Men Compared to Heterosexual Populations in Sweden, the Netherlands, and the United States

“…From the Netherlands, 107 rectal swab samples were collected at the Public Health Service in Amsterdam in 2008 and 2009. The Dutch samples were previously described by Quint et al (29). From the United States, 145 rectal swab samples from MSM were collected at Johns Hopkins University in Baltimore, MD, in 2010 and 2011, and samples from across the United States (Boston, New York, Washington, DC, Atlanta, San Francisco, and Los Angeles) were also collected.…”

“…The latter is now referred to as genovar determination. Genovars E, D, and F are highly prevalent in heterosexual populations worldwide (23,26,31,33), while genovars G, D, and J predominate in MSM populations (2,20,22,29,32). Since 2003, clonal outbreaks of invasive strains of C. trachomatis causing lymphogranuloma venereum (LGV) with severe proctitis have been described among MSM in Europe, often in combination with HIV and other sexually transmitted diseases.…”

Emancipating Chlamydia: Advances in the Genetic Manipulation of a Recalcitrant Intracellular Pathogen

“…Mixed infections are also prevalent in populations with a high propensity for acquiring STDs (108,111,(130)(131)(132)(133). Moreover, opportunities for intrabiovar recombination events are abundant in coinfections of the rectal mucosa with LGV and noninvasive urogenital strains, such as those from serotypes D, G, J, E, F, and K, that also infect the rectum (134)(135)(136)(137)(138)(139). Alternatively, several reports suggest that chlamydial species might persist in humans as commensals of the lower gastrointestinal tract (reviewed in reference 140), which could provide fertile grounds for inter-and intrabiovar exchange of DNA.…”