Diagnosing chlamydia and managing proctitis in men who have sex with men: current UK practice

McMillan, Alison; Kell, P D; Ward, Helen; Hiv,

doi:10.1136/sti.2007.028902

Cited by 15 publications

(14 citation statements)

References 22 publications

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“…Ethics committee approval and individual patient consent were not obtained as this was considered to be a standard case finding exercise in the context of an outbreak investigation; tests performed were in line with existing clinical guidelines; and routine testing for rectal chlamydia was standard care in many clinics already and recommended by BASHH guidelines of 2006 7 9. Patients were informed of the tests that were being performed.…”

Section: Methodsmentioning

confidence: 99%

“…While urethral testing for chlamydia is now generally performed in clinics, rectal screening is not routinely done in all clinics 7. We therefore carried out a case finding exercise in which routine testing for chlamydia was standardised in four clinics in order to estimate the prevalence of LGV and non-LGV Chlamydia trachomatis (CT) in MSM in the UK, and to determine whether there is a significant amount of asymptomatic urogenital or rectal LGV infection that may be acting as a reservoir of undiagnosed and untreated infection.…”

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confidence: 99%

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The prevalence of lymphogranuloma venereum infection in men who have sex with men: results of a multicentre case finding study

Ward¹,

Alexander²,

Carder

et al. 2009

Sexually Transmitted Infections

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Objective:To determine the prevalence of lymphogranuloma venereum (LGV) and non-LGV associated serovars of urethral and rectal Chlamydia trachomatis (CT) infection in men who have sex with men (MSM).Design:Multicentre cross-sectional survey.Setting:Four genitourinary medicine clinics in the United Kingdom from 2006–7.Subjects:4825 urethral and 6778 rectal samples from consecutive MSM attending for sexual health screening.Methods:Urethral swabs or urine and rectal swabs were tested for CT using standard nucleic acid amplification tests. Chlamydia-positive specimens were sent to the reference laboratory for serovar determination.Main outcome:Positivity for both LGV and non-LGV associated CT serovars; proportion of cases that were symptomatic.Results:The positivity (with 95% confidence intervals) in rectal samples was 6.06% (5.51% to 6.66%) for non-LGV CT and 0.90% (0.69% to 1.16%) for LGV; for urethral samples 3.21% (2.74% to 3.76%) for non-LGV CT and 0.04% (0.01% to 0.16%) for LGV. The majority of LGV was symptomatic (95% of rectal, one of two urethral cases); non-LGV chlamydia was mostly symptomatic in the urethra (68%) but not in the rectum (16%).Conclusions:Chlamydial infections are common in MSM attending for sexual health screening, and the majority are non-LGV associated serovars. We did not identify a large reservoir of asymptomatic LGV in the rectum or urethra. Testing for chlamydia from the rectum and urethra should be included for MSM requesting a sexual health screen, but serovar-typing is not indicated in the absence of symptoms. We have yet to identify the source of most cases of LGV in the UK.

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

The prevalence of lymphogranuloma venereum infection in men who have sex with men: results of a multicentre case finding study

Ward¹,

Alexander²,

Carder

et al. 2009

Sexually Transmitted Infections

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“…The majority of cases manifest with an acute rectal syndrome, a minority present with anogenital ulcers or buboes of the inguinal/urethral syndrome 8 9. However, LGV subtyping is usually only performed on men with symptomatic Ct proctitis,10 leading to concerns that inguinogenital and asymptomatic rectal infections may be missed. Symptomatic and asymptomatic pharyngeal LGV infections have also been reported 11…”

Section: Introductionmentioning

confidence: 99%

Risk factors for rectal lymphogranuloma venereum in gay men: results of a multicentre case-control study in the UK

et al. 2014

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ObjectiveTo identify risk factors for rectal lymphogranuloma venereum (rLGV) in men who have sex with men (MSM).DesignA case-control study at 6 UK hospitals compared MSM with rLGV (cases) with rLGV-negative controls: MSM without potential rLGV symptoms (CGa) and separately, MSM with such symptoms (CGs).MethodsBetween 2008 and 2010, there were 90 rLGV cases, 74 CGa and 69 CGs recruited. Lifestyles and sexual behaviours in the previous 3 months were reported using internet-based computer-assisted self-interviews. Logistic regression was used to investigate factors associated with rLGV.ResultsCases were significantly more likely to be HIV-positive (89%) compared with CGa (46%) and CGs (64%). Independent behavioural risks for rLGV were: unprotected receptive anal intercourse (adjusted OR (AOR)10.7, 95% CI 3.5 to 32.8), fisting another (AOR=6.7, CI 1.8 to 25.3), sex under the influence of gamma-hydroxybutyrate (AOR=3.1, CI 1.3 to 7.4) and anonymous sexual contacts (AOR=2.7, CI 1.2 to 6.3), compared with CGa; unprotected insertive anal intercourse (AOR=4.7, CI 2.0 to 10.9) and rectal douching (AOR=2.9 CI 1.3 to 6.6), compared with CGs. An incubation period from exposure to symptoms of 30 days was indicated.ConclusionsUnprotected receptive anal intercourse is a key risk factor for rectal LGV with the likelihood that rectal-to-rectal transmission is facilitated where insertive anal sex also occurs. The association between HIV and rLGV appears linked to HIV-positive men seeking unprotected sex with others with the same HIV status, sexual and drug interests. Such men should be targeted for frequent STI screening and interventions to minimise associated risks.

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“…Despite infrequent identification of C trachomatis in the pharynx of MSM, a recent survey found that onequarter of UK genitourinary medicine clinics offer routine pharyngeal chlamydia screening to MSM attendees. 4 As no prospective data exist, we sought to investigate prevalence, incidence and predictors of pharyngeal C trachomatis among the community based Health in Men (HIM) cohort of homosexual men in Sydney, Australia.…”

mentioning

confidence: 99%

Prevalence, incidence and risk factors for pharyngeal chlamydia in the community based Health in Men (HIM) cohort of homosexual men in Sydney, Australia

Templeton

Jin

Imrie

et al. 2008

Sexually Transmitted Infections

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Diagnosing chlamydia and managing proctitis in men who have sex with men: current UK practice

Abstract: There is a wide variation in the diagnosis and management of chlamydial infection in MSM and there is an urgent need for a more consistent approach.

Cited by 15 publications

References 22 publications

The prevalence of lymphogranuloma venereum infection in men who have sex with men: results of a multicentre case finding study

The prevalence of lymphogranuloma venereum infection in men who have sex with men: results of a multicentre case finding study

Risk factors for rectal lymphogranuloma venereum in gay men: results of a multicentre case-control study in the UK

Prevalence, incidence and risk factors for pharyngeal chlamydia in the community based Health in Men (HIM) cohort of homosexual men in Sydney, Australia

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