Genitourinary Medicine Clinic Research Articles

P-375 Optimising vaginal biospecimen collection

Abstract Study question Are menstrual tampons an acceptable and comparable method to lower vaginal swabs (LVS) for analysing the vaginal microbiome in non-pregnant women? Summary answer Tampons capture a higher bacterial load, volunteers are familiar with them, thus are well-accepted, and can be efficiently frozen at -20 °C prior to analysis. What is known already The vaginal microbiome plays a key role in women’s reproductive health. The application of investigating this niche allows a greater understanding of the impact of the vaginal microbiota in diverse reproductive disorders including infertility, recurrent miscarriage, spontaneous preterm birth and sexually transmitted infections. Fear and embarrassment related to physicians taking a traditional vaginal swab using a speculum results in many female genitourinary health appointments to be missed in the UK and recruitment challenges into vaginal microbiota research studies. Growing evidence suggests a menstrual tampon to be a superior alternative biospecimen collection device to a vaginal swab. Study design, size, duration This was a prospective, cross-sectional observational study. Twenty-one healthy volunteers (average age 30 years) were recruited over a period of 6 weeks at the Centre for Women's Health Research, University of Liverpool, an academic, tertiary referral centre. Participants/materials, setting, methods The volunteers consented to wearing a tampon for 20 minutes, taking 2 LVS and completing an acceptability questionnaire. Samples were halved for immediate processing and freezing at -20 °C for 2-4 weeks. Real-time PCR using Femoflor-16 was carried out to identify microorganisms present in vaginal microbiota. Microbiota was classified by total bacterial mass and relative abundance of lactobacillus species. Statistical analysis was carried out using GraphPad PRISM 5, Microsoft Excel 2019 and IBM SPSS Statistics 27. Main results and the role of chance Of the 84 samples, four had insufficient material for the purpose of analysis. Three of these were LVS samples and the fourth was a frozen tampon sample. Mean tampon total bacterial mass was higher for fresh and frozen samples versus the mean LVS total bacterial mass. The Femoflor algorithm gave identical vaginal microbiota characterisation between the fresh tampon and fresh LVS in 68.4% (13/19) of cases. 92% (12/13) samples with over 80% relative abundance of lactobacillus in the LVS also had over 80% relative abundance in the tampon. More discrepancy was seen between samples within the 20-80% and <20% relative abundance groups of lactobacillus in the LVS with 50% and 75% different classifications respectively. Importantly, only one case showed an LVS with lactobacillus >80% (normal) and a tampon with non-dominance of lactobacillus (<80%, dysbiosis). The questionnaires revealed that 90.5% of the volunteers highly rated using tampons (3 or more out of 5 on a Likert scale), with 52.4% rating tampon-use at 5/5. All participants (100%) stated that they would be happy to provide a tampon sample for clinical/research testing purposes in the future. Limitations, reasons for caution This study included 21 healthy volunteers; this is not necessarily representative of the entire UK population, but the tampon and LVS from the same volunteer were consistently comparable before and after freezing. We used a multiplex PCR assay to target common vaginal bacteria, inevitably some bacteria have not been characterised. Wider implications of the findings Self-collected tampons are suitable, well accepted biospecimen collection devices that may reduce barriers posed due to embarrassment, improve attendance in genitourinary medicine clinics and encourage participation in vaginal microbiota research. Freezing before processing reduces time and costs. A large study is necessary to ensure reproducibility and acceptability to patient population. Trial registration number Not Applicable

Public health impact and cost-effectiveness of gonorrhoea vaccination: an integrated transmission-dynamic health-economic modelling analysis

SummaryBackgroundGonorrhoea is a rapidly growing public health threat, with rising incidence and increasing drug resistance. Evidence that the MeNZB and four-component serogroup B meningococcal (4CMenB) vaccines, designed against Neisseria meningitidis, can also offer protection against gonorrhoea has created interest in using 4CMenB for this purpose and for developing gonorrhoea-specific vaccines. However, cost-effectiveness, and how the efficacy and duration of protection affect a gonorrhoea vaccine's value, have not been assessed.MethodsWe developed an integrated transmission-dynamic health-economic model, calibrated using Bayesian methods to surveillance data (from the Genitourinary Medicine Clinic Activity Dataset and the Gonococcal Resistance to Antimicrobials Surveillance Programme) on men who have sex with men (MSM) in England. We considered vaccination of MSM from the perspective of sexual health clinics, with and without vaccination offered to all adolescents in schools (vaccination before entry [VbE]), comparing three realistic approaches to targeting: vaccination on attendance (VoA) for testing; vaccination on diagnosis (VoD) with gonorrhoea; or vaccination according to risk (VaR), offered to patients diagnosed with gonorrhoea plus individuals who test negative but report having more than five sexual partners per year. For the primary analysis, vaccine impact was assessed relative to no vaccination in a conservative baseline scenario wherein time-varying behavioural parameters (sexual risk behaviour and screening rates) stabilise. To calculate the value of vaccination per dose administered, the value of vaccination was calculated by summing the averted costs of testing and treatment, and the monetary value of quality-adjusted life-year (QALY) gains with a QALY valued at £20 000. Costs were in 2018–19 GB£, and both costs and QALYs were discounted at 3·5% per year. We analysed the effects of varying vaccine uptake (0·5, 1, or 2 times HPV vaccine uptake by MSM in sexual health clinics in England), vaccine efficacy (1–100%) and duration of protection (1–20 years), and the time-horizon considered (10 years and 20 years). In addition, we calculated incremental cost-effectiveness ratios for the use of 4CMenB using assumed vaccine prices.FindingsVbE has little impact on gonorrhoea diagnoses, with only 1·7% of MSM vaccinated per year. VoA has the largest impact but requires more vaccine doses than any other strategy, whereas VoD has a moderate impact but requires many fewer doses than VoA. VaR has almost the same impact as VoA but with fewer doses administered than VoA. VaR is the most cost-effective strategy for vaccines of moderate efficacy or duration of protection (or both), although VoD is more cost-effective for very protective and long-lasting vaccines. Even under conservative assumptions (efficacy equivalent to that of MeNZB and protection lasting for 18 months after two-dose primary vaccination and 36 months after single-dose booster vaccination), 4CMenB administered under VaR would likely be cost-saving at its current National Health Service price, averting an estimated mean 110 200 cases (95% credible interval 36 500–223 600), gaining a mean 100·3 QALYs (31·0–215·8), and saving a mean £7·9 million (0·0–20·5) over 10 years. A hypothetical gonorrhoea vaccine's value is increased more by improving its efficacy than its duration of protection—eg, 30% protection lasting 2 years has a median value of £48 (22–85) per dose over 10 years; doubling efficacy increases the value to £102 (53–144) whereas doubling the duration of protection increases it to £72 (34–120).InterpretationWe recommend that vaccination of MSM against gonorrhoea according to risk in sexual health clinics in England with the 4CMenB vaccine be considered. Development of gonorrhoea-specific vaccines should prioritise maximising efficacy over duration of protection.FundingMedical Research Council (UK), National Institute for Health Research (UK).

Urethritis in men

Urethritis is simply defined as inflammation of the urethra. In the majority of cases, urethritis is caused by a sexually transmitted infection. Urethritis is the most common condition diagnosed and treated among men attending genito-urinary medicine (GUM) clinics in the UK. This article aims to outline the assessment and management of urethritis in both primary care and GUM clinics.

High-resolution genotyping of Lymphogranuloma Venereum (LGV) strains of Chlamydia trachomatis in London using multi-locus VNTR analysis-ompA genotyping (MLVA-ompA).

BackgroundLymphogranuloma venereum (LGV) is caused by Chlamydia trachomatis strains with ompA genotypes L1 to L3. An LGV epidemic associated with the L2b genotype has emerged in the past few decades amongst men who have sex with men (MSM). C. trachomatis genotypes can be discriminated by outer membrane protein A gene (ompA) sequencing, however this method has limited resolution. This study employed a high-resolution genotyping method, namely, multi-locus tandem repeat (VNTR) analysis with ompA sequencing (MLVA-ompA), to assess the distribution of LGV MLVA-ompA genotypes amongst individuals attending genitourinary medicine (GUM) clinics in London.MethodsClinical specimens were collected from individuals attending eight London-based GUM clinics. Specimens that tested positive for C. trachomatis by commercial nucleic acid amplification test (NAAT) were confirmed as LGV by pmpH real-time PCR. LGV-positive DNA extracts were subsequently genotyped using MLVA-ompA.ResultsTwo hundred and thirty DNA extracts were confirmed as LGV, and 162 (70%) yielded complete MLVA-ompA genotypes. Six LGV MLVA-ompA genotypes were identified: 1.9.2b-L2, 1.9.3b-L2b, 1.9.2b-L2b, 1.9.2b-L2b/D, 1.4a.2b-L2b, and 5.9.2b-L1. The following LGV ompA genotypes were identified (in descending order of abundance): L2, L2b, L2b/D, and L1. Eight ompA sequences with the hybrid L2b/D profile were detected. The hybrid sequence was identical to the ompA of a recombinant L2b/D strain detected in Portugal in 2017.ConclusionsThe L2 ompA genotype was found to predominate in the London study population. The study detected an unusual hybrid L2b/D ompA profile that was previously reported in Portugal. We recommend further monitoring and surveillance of LGV strains within the UK population.

Seroprevalence of human herpesvirus 8 in Ireland among blood donors, men who have sex with men, and heterosexual genitourinary medicine and infectious diseases clinic attendees.

Human herpesvirus 8 (HHV-8) seroprevalence varies geographically and between subpopulations. High seroprevalence rates have been ascribed to men who have sex with men (MSM), African migrants, and HIV-infected individuals. The objective of this study was to determine the seroprevalence of HHV-8 in an Irish population, including specific risk groups. A cross-sectional study of 200 blood donors and 200 genitourinary medicine (GUM) and infectious diseases (ID) clinic patients was performed, with testing for Immunoglobulin G(IgG) antibodies to HHV-8 lytic antigens using a commercial indirect fluorescence assay (Scimedx Corp.). Verification was performed at the Centers for Disease Control and Prevention (CDC). All 200 blood donor samples were negative for HHV-8 IgG antibodies. 21% of GUM and ID patients were positive for HHV-8 IgG antibodies. One hundredof these patients were MSM, 35% of whom were HHV-8 seropositive (46% of HIV-positive MSM and 24% of HIV-negative MSM). Of 100 heterosexual patients, only 7% were HHV-8 seropositive. The absence of seropositivity in 200 Irish blood donors may suggest that Ireland has a low overall population HHV-8 seroprevalence. The proportion of HHV-8 seropositivity in the MSM population was significantly higher than in the heterosexual population and most marked in HIV-positive MSM.

Sexually transmitted infections in primary care

Sexually transmitted infections (STIs) have often been managed in genitourinary medicine clinics. However, with increasing rates of STIs, more patients are now presenting to primary care services. It can be a sensitive subject for patients, who may be embarrassed to attend. A non-judgemental approach and knowledge about STIs are important in easing patients’ anxieties. This article provides an overview of the most common STIs in the UK, including presenting features and primary care investigation and management.

Opposing associations of depression with sexual behaviour: implications for epidemiological investigation among gay, bisexual and other men who have sex with men

ObjectiveThe aim of this report is to investigate the nature of the relationship between depression and condomless sex (CLS) among gay, bisexual and other men who have sex with men...

Unintended consequences: the potential impacts of the British Association for Sexual Health and HIV (BASHH) 2019 gonorrhoea guidelines.

In 2019 the British Association for Sexual Health and HIV (BASHH) guidelines for the management of gonorrhoea were updated. Epidemiological treatment was reserved for sexual contacts presenting within 14 days of exposure only. The aim of this evaluation was to review the potential implications of the new guidelines on the management of gonorrhoea contacts. For this retrospective service evaluation, all gonorrhoea contacts presenting to two UK sexual health services in 2018 were identified using the Genitourinary Medicine Clinic Activity Dataset (GUMCAD) code Partner notification: gonorrhoea contact (PNG). Demographics, clinical characteristics and outcome data were collected from the electronic patient records. The 2019 guidelines were retrospectively applied to evaluate impact. For 436 patients seen as gonorrhoea contacts, gonorrhoea prevalence was 36% (159/436), and chlamydia prevalence 19% (83/429). Gonorrhoea prevalence varied with sexual risk: women 57% (61/107), heterosexual men 20% (28/143), men who have sex with men (MSM) 38% (69/183, p < .001); and with time since exposure: prevalence 43% (114/267) in those presenting within 14 days, 28% (42/149) after 14 days (p = .003). Epidemiological treatment of contacts presenting within 14 days would result in the treatment of 73% (114/156) of confirmed cases, with 37% (153/416) contacts unnecessarily treated. The BASHH gonorrhoea guideline changes represent an opportunity to improve antibiotic stewardship by reducing unnecessary treatment of gonorrhoea negative contacts.

Use of HIV pre-exposure prophylaxis among men who have sex with men in England: data from the AURAH2 prospective study

BackgroundSince October, 2017 (and until October, 2020), pre-exposure prophylaxis (PrEP) has only been available in England, UK, through the PrEP Impact Trial, by purchasing it from some genitourinary medicine clinics, or via online sources. Here we report changes from 2013 to 2018 in PrEP and postexposure prophylaxis (PEP) awareness and use among HIV-negative gay, bisexual, and other men who have sex with men (MSM) and assess predictors of PrEP initiation.MethodsIn the prospective cohort study Attitudes to, and Understanding of Risk of Acquisition of HIV 2 (AURAH2), MSM were recruited from three sexual health clinics in England: two in London and one in Brighton, UK. Men were eligible if they were aged 18 years or older and HIV-negative or of unknown HIV status. Participants self-completed a baseline paper questionnaire at one of the three clinics between July 30, 2013, and April 30, 2016, and were subsequently able to complete 4-monthly and annual online questionnaires, which were available between March 1, 2015, and March 31, 2018, and collected information on sociodemographics, health and wellbeing, HIV status, and sexual behaviours. PrEP and PEP use in the previous 12 months was obtained at baseline and in annual questionnaires. We assessed trends over calendar time in 3-month periods from first enrolment to the end of the study period (July–December, 2013, was counted as one period) in use of PrEP and PEP using generalised estimating equation logistic models. We used age-adjusted Poisson models to assess factors associated with PrEP initiation among participants who reported never having used PrEP at baseline.Findings1162 men completed a baseline questionnaire, among whom the mean age was 34 years (SD 10·4), and of those with available data, 942 (82%) of 1150 were white, 1076 (94%) of 1150 were gay, and 857 (74%) of 1159 were university educated. 622 (54%) of 1162 men completed at least one follow-up online questionnaire, of whom 483 (78%) completed at least one annual questionnaire. Overall, PrEP use in the past year increased from 0% (none of 28 respondents) in July to December, 2013, to 43% (23 of 53) in January to March, 2018. The corresponding increase in PrEP use among men who reported condomless sex with two or more partners was from 0% (none of 13 respondents) to 78% (21 of 27). PEP use peaked in April to June, 2016, at 28% (41 of 147 respondents), but decreased thereafter to 8% (four of 53) in January to March, 2018. Among 460 men who had never used PrEP at baseline, predictors of initiating PrEP included age 40–44 years (incidence rate ratio [IRR] 4·25, 95% CI 1·14–15·79) and 45 years and older (3·59, 1·08–11·97) versus younger than 25 years; and after adjustment for age, recent HIV test (5·17, 1·89–14·08), condomless sex (5·01, 2·16–11·63), condomless sex with two or more partners (5·43, 2·99–9·86), group sex (1·69, 1·01–2·84), and non-injection chemsex-related drugs use (2·86, 1·67–4·91) in the past 3 months, PEP use (4·69, 2·83–7·79) in the past 12 months, and calendar year (Jan 1, 2017, to March 31, 2018 vs July 30, 2013, to Dec 31, 2015: 21·19, 9·48–47·35). Non-employment (0·35, 0·14–0·91) and unstable or no housing (vs homeowner 0·13, 0·02–0·95) were associated with reduced rates of PrEP initiation after adjustment for age. About half of PrEP was obtained via the internet, even after the PrEP Impact trial had started (11 [48%] of 23 respondents in January to March, 2018).InterpretationPrEP awareness and use increased substantially from 2013 to 2018 among a cohort of MSM in England. Improving access to PrEP by routine commissioning by National Health Service England could increase PrEP use among all eligible MSM, but should include public health strategies to target socioeconomic and demographic disparities in knowledge and use of PrEP.FundingNational Institute for Health Research.

Improved results demonstrated in the 2017 national audit of early syphilis management in the United Kingdom.

The revised British Association of Sexual Health and HIV UK guidelines on the management of syphilis were published in 2015 and this audit measures performance against those standards and recommendations. Although not included in the guideline recommendations, an exploratory question on clinics’ HIV testing policy was also included. The audit was conducted over a two-month period in 2017 in genitourinary medicine (GUM) clinics across the UK of cases presenting in 2016. A total of 161 GUM clinics participated, and data were collected for 3017 cases. The standard for adherence to recommended treatment was met (97%, standard: 97%) and almost met for documented pre-treatment syphilis serology (95%, standard: 97%). Even though only 74% of patients had a documented action in relation to informing sexual contacts (standard: 97%), the standard for contacts seen and tested per index case within four weeks was met (0.9, standard: 0.6). Finally, those clinics with a formal policy on HIV testing after a syphilis diagnosis were twice as likely to test after the HIV window period, compared to clinics without a policy; a concurrent HIV diagnosis was made in 75 (3%) patients. More work is required to standardize documented delivery of effective partner notification and a formal policy on HIV testing appears to be effective.

Investigating Conceptual Models for the Relationship Between Depression and Condomless Sex Among Gay, Bisexual, and Other Men Who have Sex with Men: Using Structural Equation Modelling to Assess Mediation

The aim of this study is to investigate five hypothesized mechanisms of causation between depression and condomless sex with ≥ 2 partners (CLS2+) among gay, bisexual, and other men who have sex with men (GBMSM), involving alternative roles of self-efficacy for sexual safety and recreational drug use. Data were from the AURAH cross-sectional study of 1340 GBMSM attending genitourinary medicine clinics in England (2013–2014). Structural equation modelling (SEM) was used to investigate which conceptual model was more consistent with the data. Twelve percent of men reported depression (PHQ-9 ≥ 10) and 32% reported CLS2+ in the past 3 months. AURAH data were more consistent with the model in which depression was considered to lead to CLS2+ indirectly via low self-efficacy for sexual safety (indirect Beta = 0.158; p < 0.001) as well as indirectly via higher levels of recreational drug use (indirect Beta = 0.158; p < 0.001). SEM assists in understanding the relationship between depression and CLS among GBMSM.

Mixed-methods study in England and Northern Ireland to understand young men who have sex with men’s knowledge and attitudes towards human papillomavirus vaccination

ObjectivesMen who have sex with men (MSM) are at greater risk for human papillomavirus (HPV)-associated cancers. Since 2016, MSM have been offered the HPV vaccination, which is most effective when...

Macrolide-resistant Mycoplasma genitalium in male and female patients attending a Northern Irish Genitourinary Medicine Clinic

Background Mycoplasma genitalium (MG) can cause urethritis in men and pelvic inflammatory disease in women. Despite the increasing rate of MG resistance to first-line macrolide treatment due to 23S rRNA gene mutations, the availability of testing remains limited in UK laboratories. This study obtained preliminary data on the rate of macrolide resistant strains circulating in N. Ireland. Methods Clinical specimens from 1052 patients attending a Genitourinary Medicine (GUM) clinic in Belfast from April 2017 to April 2018 were screened using an in-house MG PCR assay. MG positive samples were subsequently tested using Resistance Plus™ MG assay (Speedx, Australia) to detect 23S rRNA gene mutations associated with macrolide resistance. Results Amongst all study samples, 3.9 % (n=41) tested positive for MG. Out of these 41.5 % (n=17) had a 23S rRNA mutation. The rate of MG was highest in rectal swabs (8.13 %) followed by vaginal swabs (4.96 %) and then male urines (2.85 %). The rate of 23 S rRNA mutations associated with macrolide resistance in positive vaginal swabs was 21.4 % whereas the rate amongst urine and rectal swabs was at least 50 %. Conclusion Data from this study adds to the evidence base to perform MG testing in risk groups in N. Ireland to improve patient outcomes and reduce antimicrobial resistance.

Associations of depression and anxiety symptoms with sexual behaviour in women and heterosexual men attending sexual health clinics: a cross-sectional study

ObjectiveTo assess the association of symptoms of depression and anxiety with sexual risk behaviour and history, among women and heterosexual men attending genitourinary medicine (GUM) clinics.MethodsAttitudes to and Understanding of...

Perceptions of HIV testing venues among men who have sex with men in London and the Midlands, United Kingdom

Undiagnosed HIV and late HIV diagnosis increase the risk of poor disease prognosis in infected individuals and of onward HIV transmission. It is vital to encourage regular HIV testing among men who have sex with men (MSM), a group disproportionately affected by HIV. A sample of 18 MSM from London and the East Midlands in England were interviewed regarding their perceptions of testing in the following three contexts: genitourinary medicine (GUM) clinics, community settings, and at home using a self-testing kit. The data were analyzed using qualitative content analysis. Perceived stigma from health care professionals, fear of being seen by significant others, and delays in being attended to were seen as barriers to testing in GUM clinics. While community settings were viewed as more accepting of sexual identity, concerns around homophobia and HIV stigma impeded access to testing for some individuals. HIV self-testing alleviated confidentiality concerns, but interviewees doubted the accuracy of the test results and worried about the lack of social support in the event of a reactive test result. Recommendations are offered for improving the acceptability of HIV testing in these contexts.

Do healthcare professionals and young adults know about the National Chlamydia Screening Programme? Findings from two cross-sectional surveys.

The extent to which healthcare professionals (HCPs) and young people (YP) are aware of, and adhere to, National Chlamydia Screening Programme (NCSP) recommendations on testing frequency is unclear. To address this two cross-sectional surveys in 2015-2016: one among genitourinary medicine (GUM) and non-GUM HCPs (n = 109) and the other among YP attending a GUM clinic in England (n = 195). For both, questions were designed to measure awareness of NCSP guidance and whether respondents acted on that knowledge. This included questions about YP's most recent test(s) (if ever) and the time since first and last sex with their most recent partners. Knowledge of NCSP testing guidelines varied among both GUM and non-GUM HCP respondents. However, lack of knowledge of the guidelines did not preclude HCPs from recommending testing in line with NCSP recommendations in practice. While most YP were not aware of NCSP recommendations, around two-thirds had tested for Chlamydia at least once in the last year. However, testing seldom appeared to coincide with partnership change. There is a knowledge gap and a discord between testing recommendations and practice. Interventions are needed to encourage appropriate testing patterns to maximise the individual and public health benefits of testing.

Modelling-based evaluation of the costs, benefits and cost-effectiveness of multipathogen point-of-care tests for sexually transmitted infections in symptomatic genitourinary medicine clinic attendees

ObjectivesTo quantify the costs, benefits and cost-effectiveness of three multipathogen point-of-care (POC) testing strategies for detecting common sexually transmitted infections (STIs) compared with standard laboratory testing.DesignModelling study.SettingGenitourinary medicine (GUM) services...

166 Enjoy yourself, it's later than you think!

Erectile Dysfunction (ED) affects 10% of men and those affected may present at Genitourinary Medicine clinics. It may indicate significant underlying pathology and is often the first presenting symptom of cardiovascular disease (CVD) and diabetes. All new referrals to the sexual dysfunction clinic in 2006 were identified. Electronic medical records were reviewed to determine clinical outcomes 10 years after initial attendance. 138 patients identified; 9 were excluded due to unavailable records. Mean age at referral was 47 years. 68% (n=88) had predominantly organic ED (mean age 52 years) whilst 32% (n=41) were diagnosed with an underlying psychological cause (mean age 37). Of those with an organic cause, 20% (n=18) had known CVD and 17% (n=15) had diabetes. By 2016, 10% (n=13) of all patients had died. Of those alive, 30% (n=35) remained on treatment for ED. In the intervening years, a further 10 patients were diagnosed with CVD, 9 diabetes, 3 peripheral vascular disease, 3 Parkinson’s disease and 2 with stroke. Of those initially referred with ED, after 10 years, 41% had proven CVD, 27% were diabetic and 10% developed other associated conditions.

Management of anogenital warts

Patients often present to GPs with intimate problems that they find embarrassing. GPs need to be comfortable dealing with a vast array of sexual health problems and know when to refer to specialist genitourinary medicine (GUM) physicians. Anogenital warts are common, with approximately 130 000 cases treated annually in GUM clinics throughout the UK. However, for patients who do not wish to attend GUM services, or when these are not easily accessible, a basic knowledge of current guidance is essential to ensure that patients can be effectively managed in primary care.

Observed Treatment Responses to Short-Course Doxycycline Therapy for Rectal Lymphogranuloma Venereum in Men Who Have Sex With Men.

Lymphogranuloma venereum (LGV) has reestablished itself as an endemic sexually transmitted infection in the United Kingdom and elsewhere in Europe and North America over the last decade. Current guidelines suggest treatment with 21 days of doxycycline; however, the evidence base for LGV treatment including its duration is very limited. We conducted a retrospective review in 2 central London genitourinary medicine clinics of men who have sex with men (MSM) with LGV in whom less than 21 days of doxycycline was used initially. Sixty MSM were treated initially with less than 21 days of doxycycline, of whom 50 (83%) were prescribed a 7-day course. Fifty percent of patients were asymptomatic, with the rest having rectal or other symptoms. Fifty-nine (97%) of 60 had a negative test of cure for LGV at a median of 31 days (7-200 days). Reinfection as opposed to treatment failure was considered likely in the patient testing positive. A second test of cure at a median of 139 days later (37-638 days) was completed in 30 patients, of whom 28 (93%) were negative for LGV. Seven to 14 days of doxycycline is effective in most cases of LGV with negative TOCs in 59 of 60 patients. These data suggest that 7 days of doxycycline is effective in achieving cure of rectal LGV in most MSM. There is a case for a randomized controlled trial of LGV treatment including a 7-day regimen of doxycycline.