Abstract
Infection with Chlamydia trachomatis (CT) can have distinct clinical presentations, such as trachoma, or lymphogranuloma venereum (LGV). Certain populations are at greater risk for LGV acquisition and transmission, which requires a longer duration of therapy than other urogenital CT sexually transmitted infections (STIs). Commercial assays are not available in the United States to distinguish LGV from non-LGV serovars. LGV real-time PCR was performed on rectal CT-positive samples (N = 93) obtained from men (N = 80) who ordered from a mail-in self-collection STI service between April 2021 and February 2024. pmpH gene sequencing was performed on all samples to confirm LGV versus non-LGV, and multi-locus sequence typing (MLST) was performed on LGV-positive samples (N = 7) for additional confirmation. LGV was detected in 7.5% (7/93) of samples by real-time PCR, with pmpH sequencing and MLST confirming 100% (7/7) of these results. Overall, pmpH sequencing data was obtained for 92% (86/93) of samples with the following serovar distribution based on BLAST analysis: 54% (47/86) J, 28% (24/86) F, 9% (8/86) E and 8% (7/86) L. No individual had more than one LGV positive sample. No statistically significant associations with demographic factors were identified. LGV was detected in CT-positive rectal swabs from users of an online, mail-in, self-collect STI testing platform in Maryland. These data suggest that increased LGV reflexive testing may be warranted. These data also illustrate that mail-in programs for routine STI testing may be leveraged for public health surveillance purposes.
Published Version
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