Prevalence of lymphogranuloma venereum among anorectalChlamydia trachomatis-positive MSM using pre-exposure prophylaxis for HIV

Abstract

ObjectivesWe evaluated the prevalence of lymphogranuloma venereum (LGV) in anorectal Chlamydia trachomatis-positive French men who have sex with men (MSM) using pre-exposure prophylaxis (PrEP) for HIV. Here, we describe the clinical, biological and behavioural characteristics of these patients.MethodsLaboratories throughout French metropolitan areas performing routine testing for C. trachomatis sent positive anorectal specimens to the National Reference Centre for bacterial STIs for LGV real-time PCR targeting the pmpH gene. Identification of the C. trachomatis genovar was performed by ompA gene sequencing. For each patient, clinical, biological and sexual behaviour data were collected after obtaining written informed consent.ResultsIn 2017, 486 anorectal C. trachomatis-positive specimens from MSM PrEP users were analysed. A strain of genovar L was detected in 91 cases (18.7%). Patients with LGV were significantly more symptomatic, had more sexual partners and more concurrent syphilis compared with their non-LGV counterparts. OmpA gene sequencing, successful in two-thirds of anorectal C. trachomatis-positive specimens, showed that the LGV cases were mainly of variant L2b (n=33), followed by genovar L2 (n=27) and genetic L2b ompA variants (n=16). In 11 cases, the results indicated the occurrence of genetic exchange between L and non-L genovars.ConclusionsLGV was diagnosed in 18.7% of anorectal C. trachomatis-positive specimens from French MSM using PrEP. LGV testing should be carried out for MSM diagnosed with chlamydia and with a large number of sexual partners, high-risk practices and anorectal symptoms. These patients should be presumptively treated as having LGV. This is the first surveillance study of LGV among MSM PrEP users and monitoring should continue.

Updates on lymphogranuloma venereum

“…Similarly, in a recent French study LV‐positive samples were detected in 18.7% of anorectal CT‐positive specimens from MSM and the genovar L2 was the most prevalent 7 . In Italy, LV prevalence in CT‐positive anorectal samples from MSM was lower (4%) compared to the Portuguese and France prevalence and the genovars L2f, L2b and L2‐L2b/D‐Da were detected most commonly 5 …”

“…5,6 Similarly, in a recent French study LV-positive samples were detected in 18.7% of anorectal CT-positive specimens from MSM and the genovar L2 was the most prevalent. 7 In Italy, LV prevalence in CT-positive anorectal samples from MSM was lower (4%) compared to the Portuguese and France prevalence and the genovars L2f, L2b and L2-L2b/D-Da were detected most commonly. 5 Like in Europe, in USA, LV-associated genovars were detected in 14% of the CT-positive anorectal samples collected from seven public health laboratories between 2015 and 2018.…”

The silent epidemic of lymphogranuloma venereum inside the COVID-19 pandemic in Madrid, Spain, March 2020 to February 2021

“…The proportion of LGV of total CT during first pandemic wave was higher compared with the pre-lockdown period. This is probably because patients infected by L genotypes are more likely to have symptoms than patients infected by non-L genotypes [ 13 ], and therefore are among the only patients to receive care during the strictest lockdown. Nonetheless, it is important to note that the proportion of LGV represented 32.9% of all CT infections during February 2021, highlighting that the LGV epidemic seemed to be challenging to control, continuing its spread and replacement of non-invasive CT genotypes among vulnerable populations.…”

HIV and Sexual Dysfunction in Men

“…Among these, several SDTs could lead to physical consequences, both anatomical, hormonal and neurological, which can further aggravate sexual dysfunction. Syphilis, for example, is increasingly detected as an HIV-co-infection [196,197] and it could lead to neurological disturbances that progressively impair erectile function. Moreover, the presence of LUTS caused by STDs in HIV-infected men could further increase the sexual dysfunction [198,199].…”