Molecular Diagnosis of Lymphogranuloma Venereum in Patients with Genital Ulcer Disease

Introduction: The study sought to ascertain the prevalence of the aetiological agents of genital discharge and genital ulcer diseases in Maputo, Mozambique. Methodology: Consecutive consenting patients presenting to the Centro de Saúde do Porto in Maputo between March and April 2005 with genital discharge syndrome and/or genital ulcer diseases were recruited. Specimens were collected for the identification of STI pathogens. Results: Of 346 recruited patients, 164 were male and 182 female. The prevalence of confirmed single aetiological agents for male urethritis was as follows: N. gonorrhoeae, 35%; C. trachomatis, 10%; and M. genitalium 4%. For vaginal discharge, N. gonorrhoeae was found in11% of the women tested, followed by C. trachomatis (6.5%), bacterial vaginosis (34%), and T. vaginalis (2%). The prevalence of genital ulcers was as follows: Herpes simplex virus type 2, 62%; H. ducreyi 4 %; and C. trachomatis biovar LGV, 4%. Five percent of patients with genital ulcers had a positive syphilis serology (RPR ≥ 1:8 and confirmed by TPHA) and 35% of all tested patients were HIV-1/2 infected. Cases of mixed infections were present in 5%, 11% and 3% of patients with male urethritis, vaginal discharge, and genital ulcers respectively. Conclusion: The classic sexually transmitted infection aetiologies are still prevalent in Maputo. The study highlights the need for a periodic surveillance to inform syndromic management protocols.

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“…genitalium was found in 6% of cases in our study. This observation is similar to those of reports from Durban, South Africa [15,25].…”

Section: Discussionsupporting

confidence: 92%

“…For the diagnosis of LGV, PCR-restriction fragment length polymorphism was conducted as described by Sturm et al [15]. The Rapidiff stained smear was screened for the presence of C. granulomatis.…”

Section: Methodsologymentioning

confidence: 99%

Aetiology of sexually transmitted infections in Maputo, Mozambique

Zimba

Apalata

Sturm

et al. 2010

J Infect Dev Ctries

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“…LGV patients typically present in the secondary stage of the disease with inguinal lymphadenopathy after resolution of a painless genital ulcer (Schachter & Osoba, 1983); however, in our setting, patients usually present with a painful chancroid-like ulcer before the disease progresses to inguinal lymphadenopathy (Sturm et al, 2005).…”

Section: Introductionmentioning

confidence: 78%

Differences in Chlamydia trachomatis growth rates in human keratinocytes among lymphogranuloma venereum reference strains and clinical isolates

Joubert

Sturm

2011

Journal of Medical Microbiology

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The pathogenesis of the primary stage of lymphogranuloma venereum (LGV) is poorly understood. There is no skin cell model and LGV pathogenesis studies are therefore carried out on cells of different origin. Moreover, such studies usually use reference strains, which may have evolved over the years in culture. In this study, a model was developed in which Chlamydia trachomatis enters and grows in human keratinocytes at 37 and 33 6C. Keratinocytes were infected with fresh clinical isolates and the three LGV reference strains L1, L2 and L3. Growth was monitored for 5 days post-infection using fluorescence microscopy and image analysis software. Chlamydial replication was quicker at 37 than at 33 6C, despite 33 6C being the temperature of human skin. The serovar L2 reference strain grew significantly faster than the other strains, although the fresh clinical isolates were also serovar L2. When grown in keratinocytes at 33 6C, the L2 and L3 reference strains produced much larger inclusions than the other strains tested. This model, which utilizes keratinocytes, better simulates the conditions present at the initial site of infection in LGV than previously published literature, making it a useful tool for future LGV pathogenesis studies. In addition, the results indicate that fresh clinical isolates should be included in LGV pathogenesis studies. INTRODUCTIONPathogenesis of the primary stage of lymphogranuloma venereum (LGV) is poorly understood. There is no skin cell model and LGV pathogenesis studies are usually carried out with characterized reference strains, which may have evolved over the years in culture and may no longer reflect the isolates infecting patients today. The primary site of infection for LGV is the skin and mucosa of the genital tract. Because keratinocytes are the dominant cell type in this epithelium, we used keratinocytes in this study.Traditionally, the species Chlamydia trachomatis has been subdivided into two biovars, oculogenital (OG) and LGV biovars, based on the diseases they cause (Ward, 2002). However, clinical disease and the plasticity zone suggest that the species C. trachomatis should be divided into three biovars, the trachoma biovar, the genital biovar and the LGV biovar (Carlson et al., 2005).LGV patients typically present in the secondary stage of the disease with inguinal lymphadenopathy after resolution of a painless genital ulcer (Schachter & Osoba, 1983); however, in our setting, patients usually present with a painful chancroid-like ulcer before the disease progresses to inguinal lymphadenopathy (Sturm et al., 2005).LGV is the second most common cause of genital ulcers in Durban, South Africa, and occurs in 13.6 % of men (O'Farrell et al., 2008) and 15.4 % of women (Moodley et al., 2003) with genital ulcers.C. trachomatis is an obligate intracellular human pathogen with a biphasic life cycle. The infectious elementary body (EB) binds and enters a suitable host cell, matures to form a reticulate body that undergoes binary fission (Miyairi et al., 2006) and then recondenses t...

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“…Commercial diagnostic tests commonly used for chlamydia diagnostics are of limited use, since they do not distinguish the serotypes of C. trachomatis and do not identify LGV. Alternative nucleotide-based methods such as restriction fragment length polymorphism (25,41), real-time PCR (26), and nucleotide sequencing have been developed in order to facilitate LGV diagnosis.…”

mentioning

confidence: 99%