Lymphogranuloma Venereum Cases Research Articles

Lymphogranuloma venereum (LGV) in men who have sex with men (MSM): a re-emerging problem, Malta, 2018.

From 1 January to 30 June 2018, 11 cases of Lymphogranuloma venereum (LGV; all preserved samples (n = 4) genovar L2b) were identified at the Genitourinary Clinic (GUC), Mater Dei Hospital, Msida, Malta. All cases were diagnosed in men who have sex with men (MSM); six participated in three group-sex parties. Here, we describe the outbreak and risk factors associated with LGV diagnoses in MSM in Malta in 2018.

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.

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

Lymphogranuloma venereum (LGV) is a sexually transmitted infection (STI) caused by Chlamydia trachomatis genotypes L1, L2 and L3. This LGV is associated with significant morbidity and increased risk of HIV transmission. While fewer than two cases per year were reported in Quebec before 2005, LGV emerged in 2005-2006 with 69 cases, followed by a period of low incidence (2007-2012), and subsequent re-emergence since 2013. To describe the incidence of LGV in Quebec and the characteristics of the affected population, including demographics and risk factors, clinical manifestations, laboratory tests, treatments and reinfection rates. Descriptive data were collected from the notifiable diseases records through the Institut national de santé publique du Québec (INSPQ) infocentre portal. Questionnaires were obtained through the enhanced surveillance system and transmitted anonymously to the Quebec Ministry of Health. In-depth analysis was performed on cases from 2013 to 2016. There were 338 cases of LGV over the four-year period in Quebec. All cases were male, excluding one transsexual. Mean age was 41 years. Most lived in Montréal (81%) and were men who have sex with men (MSM; 99%). The majority (83%) reported four sexual partners or more in the last year, met mostly through the Internet (77%) and in saunas (73%). Frequency of sexual intercourse with out-of-province residents decreased in 2013-2016 (27%) compared with 2005-2012 (38%). History of STIs was frequent: 83% were HIV-infected, 81% reported previous syphilis and 78% previous gonorrhea. Recreational drug use was frequent (57%), reaching 71% in 2016. Most cases were symptomatic, a proportion which decreased in 2016 (68%) compared with 2013-2015 (82%; p=0.006). Clinical presentations included proctitis (86%), lymphadenopathy (13%) and ulcer/papule (12%). Reinfections, mostly within two years of first infection, occurred in 35 individuals (10%).Conclusion: The re-emergence of LGV in Quebec involves an urban subpopulation composed almost exclusively of MSM with STIs, who have a high number of partners and often use drugs.

Lymphogranuloma venereum rates increased and Chlamydia trachomatis genotypes changed among men who have sex with men in Sweden 2004–2016

This study aimed to determine the incidence of lymphogranuloma venereum (LGV) in Sweden since 2004 and to study in detail a consecutive number of Chlamydia trachomatis cases in men who have sex with men (MSM) during a 10 month period (September 2014 to July 2015). LGV increased from sporadic import cases in 2004 to comprise a spread within Sweden in 2016. Initially, only the L2b ompA genotype was detected, but in 2015 half of the genotyped LGV cases were L2 genotype. The changing genotype distribution in Sweden is linked to increased LGV spread in Europe. High-resolution multilocus sequence typing of 168 C. trachomatis cases from MSM in 2015 resulted in 29 sequence types, of which 3 accounted for 49 % of cases. The increased rates and different genotypes of LGV indicate that more concern for high-risk taking MSM is needed to avoid further spread of this invasive infection.

Extra-rectal lymphogranuloma venereum in France: a clinical and molecular study

ObjectivesTo describe a series of extrarectal lymphogranuloma venereum (LGV) cases diagnosed in France.MethodsConsecutive LGV cases confirmed at the French Reference Centre for chlamydiae with an extrarectal sample from January 2010...

Low Prevalence of Urethral Lymphogranuloma Venereum Infections Among Men Who Have Sex With Men: A Prospective Observational Study, Sexually Transmitted Infection Clinic in Amsterdam, the Netherlands.

In contrast to anorectal lymphogranuloma venereum (LGV), few urogenital LGV cases are reported in men who have sex with men. Lymphogranuloma venereum was diagnosed in 0.06% (7/12,174) urine samples, and 0.9% (109/12,174) anorectal samples. Genital-anal transmission seems unlikely the only mode of transmission. Other modes like oral-anal transmission should be considered.

O12 LGV testing: are we identifying all cases in a timely manner?

IntroductionBASHH recommends Lymphogranuloma venereum (LGV) testing of Chlamydia trachomatis (CT)-positive specimens from men who have sex with men (MSM) presenting with proctitis, and all rectal CT from HIV-positive MSM. Until...

Emergence of the lymphogranuloma venereum L2c genovariant, Hungary, 2012 to 2016.

In eastern Europe, few countries have so far reported laboratory-confirmed cases of lymphogranuloma venereum (LGV). Here we describe 22 LGV cases in men who have sex with men (MSM) detected in Hungary from November 2012 to July 2016. Sequence analyses show that 16 of these 22 cases were affected by the L2c genovariant, with from 2012 to 2014, one LGV L2c case detected per year, followed by seven cases in 2015 and six up to July 2016. Of the 16 total L2c LGV cases, 10 had severe haemorrhagic proctitis. These findings are concerning as cases with this new genovariant among MSM have not been frequently reported in Europe to date. More research is needed to assess the spread of the L2c genovariant and its potential association with virulence and severe clinical manifestation.

Enhanced surveillance of a lymphogranuloma venereum outbreak in Sydney 2010–2012

ObjectivesTo investigate an increase in lymphogranuloma venereum (LGV) notifications in New South Wales (NSW). MethodsEnhanced surveillance of notified LGV cases in NSW between May 2010 and April 2012 using doctor and patient questionnaires. ResultsThirty‐seven doctors who had diagnosed 67 (76%) of 88 notified anorectal LGV infections were interviewed. The majority (n=33, 89%) of treating doctors were formally trained and accredited in HIV management and prescribing, and most (n=32, 86%) worked in a public sexual health clinic or a general practice with a high caseload of men who have sex with men (MSM). All 67 cases were MSM who resided in inner‐city Sydney and all were serovar L2b. Anal symptoms had been present in 64 cases (96%, 95%CI 87–99%) for a median of 8 days (range 2–1,825) prior to presentation. Almost one‐third (n=20) had another concurrent STI diagnosed. Most (82%) of the 22 interviewed patients reported being HIV positive and having other STIs diagnosed over the past year. In the preceding month, all 22 men reported condomless anal sex and the median number of casual sexual partners was 5 (range 0–100). ConclusionsCharacteristics of LGV cases in NSW are similar to those described worldwide, suggesting that a sexually adventurous subgroup of MSM are at particular risk of infection. ImplicationsEducation of non‐sexual‐health clinicians on LGV risk factors, presentation, testing and management may allow more timely diagnosis and notification of contacts to reduce LGV transmission in the community.

O002 Rates of asymptomatic lymphogranuloma venereum (LGV) in men who have sex with men (MSM)

Background/introduction The 2015 BASHH Chlamydia guidelines recommend LGV testing in asymptomatic HIV positive, but not HIV negative, MSM with rectal chlamydia. Despite evidence for serosorting among MSM having condomless sex, up to 16% are unaware of, or have different HIV status to their sex partners. HIV positive MSM may therefore transmit LGV to serodiscordent partners, resulting in higher than expected infection rates in HIV negative MSM. Aim(s)/objectives To compare rates of asymptomatic and symptomatic LGV in HIV positive and negative MSM attending a sexual health service. Methods Case notes of individuals with confirmed LGV from 8/6/2015–31/12/2015 were reviewed and data on demographics, symptoms, HIV status and presence of other STIs collected. Results We identified 105 cases of LGV (79% White; median age 35.3 years). 48 (46%) were HIV negative. 73% of HIV negative and 56% of HIV positive individuals were asymptomatic. 50 patients (47.7%) had one or more other STIs at time of initial LGV diagnosis; 62% were HIV positive. At time of censor, 95% of individuals attending for test of cure had a negative result. Discussion/conclusion Asymptomatic LGV was identified in 73% of HIV negative individuals which is likely to have been missed had they not been tested at initial chlamydia diagnosis. STIs facilitate onward transmission of HIV and our findings highlight the importance of continuing to recommend regular screening in all MSM regardless of HIV status to identify infections and offer timely treatment. We recommend LGV testing be extended to asymptomatic HIV negative MSM with rectal chlamydia.

CC3 Lymphogranuloma Venereum presenting as a rectal tumour

Background/introduction Lymphogranuloma Venereum (LGV), due to an invasive serovar of Chlamydia Trachomatis, is endemic in the United Kingdom in men who have sex with men (MSM). It is associated with the human immunodeficiency virus (HIV) and other sexually transmitted infections including hepatitis C. Aim(s)/objectives We present a case of LGV mimicking a rectal tumour in a heterosexual male. Methods The diagnosis of LGV was made following molecular diagnostic testing of an anal swab. Results The patient presented as an emergency with a history of change in bowel habit, tenesmus and rectal bleeding. He had a past medical history of duodenitis and a family history of Crohn’s disease. Digital rectal exam revealed a circumferential rectal tumour, 2 cm from the anal verge. Features suggested a diagnosis of rectal cancer and radiological staging demonstrated extensive local infiltration and nodal involvement, supporting this diagnosis. Biopsies from colonoscopy however revealed severe proctitis with no evidence of malignancy. The local colorectal MDT meeting decided the patient would have neoadjuvant chemoradiotherapy and subsequent surgery based on response, after more biopsies. In the interim he presented with pending bowel obstruction resulting in a de-functioning colostomy and the patient tested positive for HIV prompting a referral to GUM physicians. Repeat MRIs captured the subsequent remarkable response to LGV treatment with Doxycycline. Discussion/conclusion It is important for HIV testing to be incorporated as part of the management plan for colorectal malignancies.

Steady increase of lymphogranuloma venereum cases, Czech Republic, 2010 to 2015.

Since the notification of the first case of lymphogranuloma venereum (LGV) in the Czech Republic in 2010, the numbers of LGV cases have steadily increased in the country. In 2015, 40 LGV cases were diagnosed, bringing the total for 2010-2015, to 88 cases. The profile of the most affected group, HIV-positive men who have sex with men with a previous sexually transmitted infection, matches that of those described in LGV outbreaks in western Europe.

A suspected case of lymphogranuloma venereum (LGV) suggests underdiagnosed LGV infection among Slovenian men who have sex with men

Lymphogranuloma venereum (LGV) is sexually transmitted infection caused by serovars of Chlamydia trachomatis, mostly seen among HIV-positive men who have sex with men. The first three reports of possible LGV in Slovenia were from April to June 2015, followed by a confirmed case of LGV in August 2015. We present the case of an HIV-positive MSM that presented with an anorectal abscess, discharge, lymphadenopathy, and unusual perianal plaque. Gonococcal proctitis was assumed and he received empirical antibiotic treatment, after which only intermittent improvement occurred. After a positive test result for chlamydial infection, but without a response to azithromycin treatment, LGV was suspected. Treatment according to the guidelines was introduced. When doxycycline therapy started, rapid improvement was observed, and it was therefore assumed that the LGV infection had been successfully treated. Two similar cases with an unusual anorectal presentation and an excellent response to antibiotic therapy for LGV were observed at the same center shortly thereafter. While pointing out possible delays and limitations in diagnostic procedures at self-pay facilities, the need for better access to high quality STI management in public and in private services is emphasized. Enhanced surveillance and testing guidelines could reveal a hidden LGV epidemic among MSM in Slovenia.

Epidemiology of infections by HIV, Syphilis, Gonorrhea and Lymphogranuloma Venereum in Barcelona City: a population-based incidence study.

BackgroundThe aim of this study was to determine the evolution of HIV infection, gonorrhea, syphilis and lymphogranuloma venereum (LGV), and their epidemiological characteristics in Barcelona city.MethodsPopulation-based incidence study of all newly occurring diagnoses of HIV infection, syphilis, gonorrhea and LGV detected in Barcelona between January 2007 and December 2011. A descriptive analysis was performed. The annual incidence rates per 100,000 inhabitants were calculated by sex, sexual conduct and educational level. To estimate global sex-specific rates we used the Barcelona city census; for the calculation of rates by sexual conduct and educational level we used estimates of the Barcelona Health Interview Survey. Trends were analysed using the chi-squared test for linear trend.ResultsHIV. 66.8 % of the HIV cases were men who had sex with men (MSM). The incidence rates in MSM over the study period were from 692.67/100,000 to 909.88/100,000 inh. Syphilis. 74.2 % of the syphilis cases were MSM. The incidence rates in MSM were from 224.9/100,000 to 891.97/100,000 inh. and the MSM with a university education ranged from 196.3/100,000 to 1020.8/100,000. Gonorrhea. 45.5 % of the gonorrhea cases were MSM. The incidence rates in MSM were from 164.24/100,000 to 404.79/100,000 inh. and the MSM with university education ranged from 176.7/100,000 to 530.1/100,000 inh.. Lymphogranuloma venereum (LGV). 95.3 % of the LGV cases are MSM. The incidence rates in MSM were from 24.99/100,000 to 282.99/100,000 inh. and the MSM with university education ranged from 9.3/100,000 to 265/100,000 inh.ConclusionAn increase in cases of STI was observed. These STI mainly affected MSM with a university education. Continuing to monitor changes in the epidemiology of STI, and identifying the most affected groups should permit redesigning preventive programs, with the goal of finding the most efficient way to reach these population groups.

P08.14 Lymphogranuloma venereumin the czech republic

Introduction Lymphogranuloma venereum (LGV) is caused by Chlamydia trachomatis serovars L1 – L3. LGV was considered as tropical disease with typical inguinal syndrome and it wasn’t usual in Europe until 2003, when an outbreak was observed in the Netherlands. This was followed by series of outbreaks emerging in different European countries and North America. A common feature for this epidemic is men who have sex with men (MSM) with signs of severe proctocolitis. Most of the patients are co-infected with HIV and/or other sexually transmitted infections (STI). Methods The National Reference Laboratory for Chlamydia Infections offers a diagnostic service to clinicians. The disease is confirmed by the presence of Chlamydia trachomatis and L1 – L3 serovars from multiplex PCR (Seegene). Multiplex PCR is very useful, because multiple infections are observed in many cases. Results First case of LGV was diagnosed from a lymph node puncture in 2010. Then the number of patients was slowly increasing (5–10 patients per year) and the most cases were diagnosed in 2014 (23 patients). Until March 2015, a total of 56 patients with LGV were confirmed. Characteristics of these cases were similar to those in other European countries. LGV was confirmed among MSM with high prevalence of other STI. Forty-eight patients (85%) were co-infected with HIV. In some cases, HIV and LGV were diagnosed at approximately the same time. Forty-three patients (77%) were co-infected with syphilis. The data on other STI are not completed. The vast majority of patients manifested proctocolitis. Only in few cases the inguinal syndrome was observed. Conclusion Lymphogranuloma venereum is also present among MSM in the Czech Republic. We observed, that the number of cases increases. Certainly, it is necessary to expand testing of chlamydial infection in MSM, because this disease could facilitate HIV transmission. Disclosure of interest statement Nothing to declare.

P08.15 Increasing number oflymphogranuloma venereumcases in belgium, overview 2011–2014

Introduction The surveillance of Lymphogranuloma venereum (LGV) in Belgium was reinforced in 2011 by a National Reference Centre of Sexually Transmitted Infections (NRC-STI) offering since then the confirmation of L serovar Chlamydia trachomatis by qPCR on biological material of suspected cases. The surveillance data of confirmed cases is send to the Institute of Public Health (IPH). Methods Medical laboratories are asked to send biological specimens of LGV suspected cases and which are positive for C. trachomatis to the NRC-STI to confirm the presence of the C. trachomatis L type. Sociodemographic and clinical data are collected of suspected and confirmed cases. Results The number of cases stayed stable in 2011 (N = 21) and 2012 (N = 23) but doubled (N = 45) and almost tripled (N = 59) in 2013 and 2014, respectively. Over the 4 years we observed 148 cases in 126 male patients and 1 transgender, the majority of them identified themselves as Men who have Sex with Men (MSM), being older (30–49 year) and HIV positive, with the exception of 7 HIV negative MSM in 2014. The patients were frequently co-infected with another STI. Gonorrhoea was the most frequently reported co-infection and proctitis was the predominant symptom. Sex work or contact with a sex worker was reported by four patients in 2014. Six patients experienced more than once (2–4) a LGV within 5 to 24 months since the last infection. Conclusions Over 2011–2014, LGV was detected in mainly HIV positive MSM belonging to an older age group. STI co-infections were frequently detected. The worrying finding is the multiple reinfections. It is not clear whether the re-infections are persistent infections due to treatment failure, re-infection caused by (an) untreated partner (s), or new infections. The increasing number of LGV cases and the high number of re-infections calls for sensitisation and prevention campaigns for this population. Disclosure of interest statement Nothing to declare.

Chlamydia and lymphogranuloma venereum in Canada: 2003-2012 Summary Report.

Chlamydia continues to be the most commonly reported sexually transmitted infection in Canada. Lymphogranuloma venereum (LGV), caused by certain serovars of Chlamydia trachomatis, is becoming established in some populations in a number of Western countries. To identify trends in reported cases of chlamydia and LGV in Canada from January 1, 2003 to December 31, 2012. Notifiable disease data on chlamydia were submitted to the Public Health Agency of Canada by provincial and territorial epidemiological units and summarized at the national level by age and sex. Confirmatory testing for suspected LGV cases and serovar subtyping were performed by the National Microbiology Laboratory (NML). Where possible, provincial/territorial health authorities use a standardized national case report form to collect enhanced epidemiological data on each case and to submit the data to the Agency. Rates of reported cases of chlamydia increased by 57.6%, from 189.6 to 298.7 per 100,000 between 2003 and 2012. The rate of reported cases of chlamydia among females (383.5 per 100,000) was almost twice as high as that among males (212.0 per 100,000), although the highest relative rate increase occurred among males. In both males and females, the rates of chlamydia were highest in those aged 20 to 24 years. From 2004 to 2012, 170 cases of LGV were reported to the Agency by provincial health authorities (including 104 confirmed and 66 probable cases). In 2012, case reports were received on 12 confirmed and probable cases, compared to 38 laboratory-positive cases confirmed by the NML. In Canada, as in many countries, chlamydia rates have markedly increased over the last 10 years, in part due to improved diagnosis through nucleic acid amplification (NAAT) testing. Consistent with trends in Europe and other countries, LGV is emerging in Canada among men who have sex with men (MSM).

Treatment of rectal chlamydia infection may be more complicated than we originally thought.

Rectal chlamydia diagnoses have been increasing among MSM and may also rise among women as anal sex rates increase among heterosexuals. However, there is growing concern about treatment for rectal chlamydia with treatment failures of up to 22% being reported. This article addresses factors that may be contributing to treatment failure for rectal chlamydia, including the pharmacokinetic properties of azithromycin and doxycycline in rectal tissue, the ability of chlamydia to transform into a persistent state that is less responsive to antimicrobial therapy, the impact of the rectal microbiome on chlamydia, heterotypic resistance, failure to detect cases of lymphogranuloma venereum and the performance of screening tests. If we are to reduce the burden of genital chlamydia, treatment for rectal chlamydia must be efficacious. This highlights the need for randomized controlled trial evidence comparing azithromycin with doxycycline for the treatment of rectal chlamydia.

No evidence for LGV transmission among heterosexuals in Amsterdam, the Netherlands.

BackgroundIn recent years a few cases of lymphogranuloma venereum (LGV) in heterosexuals in Europe have been reported. It is not known whether LGV transmission among heterosexuals occurs on a wider scale.MethodsHeterosexual male and female STI clinic clients (n = 587) in Amsterdam, the Netherlands, with a positive nucleic acid amplification test (NAAT) result for Chlamydia trachomatis (CT) were screened for IgA anti-MOMP in serum. If the value was above the cut-off index (2.0) the patient’s CT positive urogenital, ocular or rectal sample(s) were selected and tested for LGV by an in-house LGV-specific NAAT.ResultsSera of 126 patients were above 2.0 COI. Some patients had >1 CT positive sample. Samples could not be retrieved from 15 of the 126 persons, and 7 samples that were found positive for CT in the diagnostic amplification process could not be confirmed and hence not typed. We did not find a single case of LGV infection in 123 urogenital, ocular or rectal samples from 104 patients.ConclusionWe found no indications for significant spread of LGV infection in heterosexuals in Amsterdam. Surveillance in females with cervical or anal CT infection is indicated to monitor LGV occurrence in heterosexuals.

Pitfalls in the diagnosis and management of inguinal lymphogranuloma venereum: important lessons from a case series

Current lymphogranuloma venereum (LGV) guidelines mainly focus on anorectal infections. Inguinal LGV infections have been rare in the current epidemic among men who have sex with men (MSM), but might...