Increasing trends of lymphogranuloma venereum among HIV-negative and asymptomatic men who have sex with men, the Netherlands, 2011 to 2017

Abstract

Introduction: Lymphogranuloma venereum (LGV), an invasive form of Chlamydia trachomatis infection, has been reported among (mainly HIV-positive) men who have sex with men (MSM) since 2003. In the Netherlands, LGV testing recommendations changed from selective to universal testing in 2015. Changes in tested populations could have led to incomparable LGV positivity rates over time. Aim: We investigated LGV trends among MSM attending Centres for Sexual Health using surveillance data between 2011 and 2017. Methods: LGV positivity was calculated among MSM tested for rectal Chlamydia infection and MSM tested specifically for LGV. With multivariable logistic regression analysis, the association between years and LGV was adjusted for testing indicators and determinants. Results: We included 224,194 consultations. LGV increased from 86 in 2011 to 270 in 2017. Among LGVpositives, proportions of HIV-negative and asymptomatic MSM increased from 17.4% to 45.6% and from 31.4% to 49.3%, respectively, between 2011 and 2017. Among MSM tested for rectal chlamydia, LGV positivity increased from 0.12% to 0.33% among HIVnegatives and remained stable around 2.5% among HIV-positives. Among LGV-tested MSM, LGV positivity increased from 2.1% to 5.7% among HIV-negatives and from 15.1% to 22.1% among HIV-positives. Multivariable models showed increased odds ratios and significant positive associations between years and LGV. Conclusions: Although increased testing and changes in LGV incidence are difficult to disentangle, we found increasing LGV trends, especially when corrected for confounding. LGV was increasingly attributed to HIV-negative and asymptomatic MSM, among whom testing was previously limited. This stresses the importance of universal testing and continuous surveillance.

Rapid Increase in Lymphogranuloma Venereum among HIV-Negative Men Who Have Sex with Men, England, 2019

“…Further investigation will be needed to understand the impact of HIV prevention on transmission of bacterial STIs. However, the increasing proportion of LGV diagnoses among HIV-negative MSM during 2017–2019 is in line with reports from other countries in Europe ( 6 , 8 , 14 , 15 ).…”

“…Although LGM was initially characterized as affecting predominantly MSM living with HIV who have symptomatic proctitis ( 2 , 3 ), recent evidence suggests considerable underestimation of the actual extent of LGV among MSM in Europe because of insufficient testing of asymptomatic persons ( 4 ). Changes to UK guidelines ( 5 ) and testing practices of several large London clinics have led to expanded testing in MSM regardless of HIV status, leading to increased diagnoses among HIV-negative MSM and those without symptoms of proctitis ( 6 – 9 ). Expanded testing may have precipitated a decline in incidence during 2016–2018 ( 9 ); however, 2019 saw the highest number of LGV diagnoses reported in England since routine testing began in 2004, and test positivity increased from 8.2% in 2018 to 9.0% in 2019 ( 10 ).…”

Universal lymphogranuloma venereum (LGV) testing of rectal chlamydia in men who have sex with men and detection of asymptomatic LGV

“…Rectal LGV in MSM can present as proctitis 7–10. However, asymptomatic LGV is well recognised, has been reported among MSM in several countries,11–19 and may contribute to onward transmission.…”

Controversies and evidence on Chlamydia testing and treatment in asymptomatic women and men who have sex with men: a narrative review

“…Urogenital CT in MSM The arguments for testing urogenital CT in clinical and public health practice are mainly based on the epidemiology in women. MSM, in whom urogenital CT testing also is routinely recommended in international guidelines, generally show a lower urogenital CT positivity than women, in studies in tested clinic populations [ 41 , 42 ], although prevalence estimates are scarce. Urogenital CT was estimated to be 0.4% in the general MSM population by respondent-driven sampling in Canada [ 43 ].…”

“…A study in MSM estimated the duration of rectal CT at 13 weeks [ 94 ]. In MSM, 5–22% of all (symptomatic and asymptomatic) rectal CT is of the CT LGV biovar, although in many assessments, proportions were found at the lower end of this range [ 42 ]. Only some laboratories routinely test all rectal positive samples for LGV.…”