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

Abstract

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.

Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence

“…63 Urethral LGV was recently identified in over 2% of MSM with anorectal LGV and almost 7% of their contacts at an Amsterdam clinic, 67 with around half of these infections being asymptomatic. This report, from a relatively high-LGV prevalence setting contrasts sharply with other European 58,60 and Australian 63 data, where no reservoir of urethral LGV has been found among unselected MSM populations, irrespective of symptoms.…”

“…LGV has also been described in association with incident HCV infections among MSM. 52 However, it remains 58 have failed to identify a substantial reservoir of asymptomatic LGV infection among MSM. This contrasts with other European data, where a large proportion of asymptomatic anorectal chlamydia has been identified as LGV.…”

Lymphogranuloma venereum proctocolitis: a silent endemic disease in men who have sex with men in industrialised countries

“…Paradoxically, simultaneous penile lesions and/or inguinofemoral lymphadenopathy have been reported rarely [49]. Despite the fact that most patients had reported unprotected insertive and receptive anal sexual intercourse, only few cases of urethritis due to LGV serovars have been reported in the present outbreak [35,50]. The reason why the bubonic form or the urethral infection is not more commonly reported remains unclear.…”

“…Some patients were pauci-symptomatic or asymptomatic, up to 40% in the Dutch series, but other studies have failed to demonstrate a significant reservoir of asymptomatic or urethral infection in MSM or in the general population [2,39,40,50,51]. On the other hand, the absence of the classical clinical features of LGV have also conditioned a delay in the diagnosis and treatment in the current outbreak as evidenced by the large number of cases diagnosed retrospectively, allowing ongoing transmission [5,8,11,43,46].…”

Lymphogranuloma venereum in Quebec: Re-emergence among men who have sex with men

“…The implication of pharyngeal as well as urethral LGV in transmission of the epidemic strain remains unclear. Rectal infections have been shown to be far more common in various LGV prevalence studies (23)(24)(25)(26). It is thus arguable that extrarectal screening would not be a cost-effective measure.…”