Abstract

IntroductionLymphogranuloma 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.AimWe investigated LGV trends among MSM attending Centres for Sexual Health using surveillance data between 2011 and 2017.MethodsLGV 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.ResultsWe included 224,194 consultations. LGV increased from 86 in 2011 to 270 in 2017. Among LGV-positives, 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 HIV-negatives 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.ConclusionsAlthough 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.

Highlights

  • Lymphogranuloma venereum (LGV), an invasive form of Chlamydia trachomatis infection, has been reported among men who have sex with men (MSM) since 2003

  • The Dutch Centres for Sexual Health (CSH) surveillance data showed that rectal Chlamydia trachomatis (CT) testing, LGV testing and the number of LGV diagnoses increased among MSM between 2011 and 2017, with an increasing proportion of LGV attributed to HIV-negative

  • These crude LGV positivity trends were affected by changes in the population tested over time, as we found stronger and significant positive associations between years and LGV after correction for LGV testing indicators and risk factors

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Summary

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. 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. 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. Lymphogranuloma venereum (LGV) is a sexually transmitted infection (STI) caused by invasive L1, L2 and L3 serovars of Chlamydia trachomatis (CT). Differentiation of the LGVcausing L serovars from the non-LGV (D–K) serovars is important, as rectal LGV requires an extended doxycycline treatment regimen (21 days) compared with nonLGV rectal infection (7 days) [8,9]

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