Lymphogranuloma venereum: a retrospective analysis of an emerging sexually transmitted disease in a Lisbon Tertiary Center

Abstract

Background Lymphogranuloma venereum (LGV) is a sexual transmitted infection (STI), currently endemic within the population of men who have sex with men (MSM) of Western Countries. L2B variant has been reported as the predominant strain in the current LGV epidemics, although a shift towards L2-434 has been observed in some European countries.Objectives To evaluate and characterize the population with LGV infection diagnosed in Centro Hospitalar Universit ario de Lisboa Central, Lisbon, Portugal.Methods A retrospective analysis of all LGV diagnoses between 2016 and 2019 was performed. The diagnosis was established through ompA-genotyping of samples yielding a positive result to Chlamydia trachomatis (CT). All considered samples were retrieved from the clinician activity, through swabbing and urine analysis and CT infection diagnosis was obtained using real-time PCR.Results During the period studied 16 279 CT diagnostics tests were employed, with a striking increase from 2016 (n = 467) to 2019 (n = 9362). A total of 1602 diagnoses of CT were established, from which 168 (10.5%) corresponded to LGV, with both infections showing a rising evolution, between 2016 and 2019, of 2.9 and 2.7 times, respectively. The majority of the LGV strains were genotyped as L2/434 (67.3%; n = 113). LGV predominantly affected MSM and men who have sex with men and women (97.0%; n = 163). Anorectal infection was the most prevalent one (90.5%; n = 152), being proctitis the main clinical presentation (76.2%; n = 128). Absence of symptoms was reported in almost 15% of the cases (n = 24). The presence of concomitant infection with human immunodeficiency virus was dominant (73.2%; n = 123) and the prevalence of one or more STI co-infections was about 60.1% (n = 99).Conclusions An increasing evolution of CT and LGV testing and diagnosing was observable throughout the studied period. Characteristics of the population are similar with those described within LGV epidemics. In accordance with recent European studies, predominance towards L2 genotype was identified.

Clinical and Epidemiological Characterization of Lymphogranuloma Venereum in a Sexually Transmitted Diseases Clinic in Lisbon, 2001 to 2020

“…Predictably, this LGV/CT ratio was higher when only anorectal samples were considered (56.5%). Although similar studies have also shown a high percentage of LGV among CT-positive anorectal samples (23% in the recent Portuguese article by Neves et al 1 and 18.7% in another recent French study 8 ), our ratio was substantially higher, which may unveil the importance of this infection in Portugal. A limitation of our study is that analysis of the evolution of LGV prevalence before 2017 was not performed, as we could not retrieve data on the total number of CT tests performed and CT diagnoses before that year.…”

“…Our LGV patient group demonstrated several similarities to those reported in Europe and Western countries during the ongoing epidemics: most LGV infections occurred in MSM (87%); anorectal mucosa was the most affected location (72.2%), with proctitis being the most common symptom; and there was a high rate of other STIs among LGV-infected patients (46.3%). 1,4,9,10 However, we highlight some unexpected results, such as the fact that 13% of the infections occurred in heterosexuals, a population that is considered at low risk for LGV infection. 11 Whether transmission of LGV from the MSM community to the heterosexual population occurred or distinct transmission networks took place in Portugal, we could not evaluate through the present study.…”

“…The high rate of other concomitant STIs among LGV-infected patients that we found (46.3%) is also indicative of unsafe sexual practices and high partner turnover. The loss of mucosal barrier associated with the LGV infection might explain the high rate of coinfections 1 …”

“…T he classification of Chlamydia trachomatis (CT) species is based on the analysis of the ompA gene, which encodes for the major outer membrane protein. 1 Lymphogranuloma venereum (LGV) is a sexually transmitted infection (STI) caused by CT ompA genotypes L1-L3. Lymphogranuloma venereum is a more invasive and inflammatory disease compared with that caused by other CT genotypes (A-K), in part because L1-L3 strains have tropism for lymphatic tissues in addition to epithelial surfaces.…”

“…3,4 Lymphogranuloma venereum has become more endemic in this population, with proctitis and asymptomatic cases being reported in multiple major cities across Europe, North America, and Australia. 1 In Portugal, few epidemiological data of the LGV cases have been reported. 1,5,6 A retrospective observational study was performed to characterize all LGV cases diagnosed in the Lapa Health Center, from the first identified case in 2001 to the end of December 2020.…”