A comparison of two methods for the diagnosis of lymphogranuloma venereum

Abstract

A recent outbreak of lymphogranuloma venereum (LGV) within the men who have sex with men (MSM) community and their requirement for extended therapy has highlighted the need for laboratory tests that differentiate LGV-from non-LGV-associated serovars of Chlamydia trachomatis. Two previously described methods were evaluated against 495 clinical specimens referred to the Sexually Transmitted Bacteria Reference Laboratory (London, UK): (i) PCR amplification of a 1.1 kb region of the ompI gene followed by restriction enzyme digestion (ompI RFLP-PCR); and (ii) real-time PCR targeting a 36 bp deletion present within the polymorphic membrane protein H gene of LGV-associated serovars (pmpH real-time PCR). For specimens that could be categorized using both methods, a 94.7 % (390/412) concordance was achieved. Eighty-three specimens were found to be untypeable by ompI RFLP-PCR due to a failure to amplify the 1.1 kb fragment. Of these 83 untypeable specimens, 19 were determined to be an LGV-associated serovar by pmpH real-time PCR. Despite the high level of concordance, there were differences found in the technical complexity of the two methods. The pmpH real-time PCR exhibited greater sensitivity, a more rapid turnaround time and a lower technical requirement. Whilst the ompI RFLP-PCR was not as robust as a laboratory diagnostic method, it did enable serovar-level identification.LGV infection remains an important threat to the health of high-risk MSM in Europe. In conclusion, the two methods for the detection of LGV from clinical samples were found not only to have a high concordance (94.7 %) but also to be complementary, and could be used in an integrated way to aid LGV detection.

2019 European guideline on the management of lymphogranuloma venereum

“…There are multiplex NAATs for genital ulcerative disease that detect LGV but these have not yet been appropriately evaluated in the context of rectal LGV. Different in‐house or laboratory‐developed NAATs have been designed and used . The sensitivities of these NAATs are generally lower than the commercially available C. trachomatis screening NAAT …”

Screening for asymptomatic lymphogranuloma venereum co-infection in men who have sex with men newly diagnosed with HIV, hepatitis C or syphilis

“…5 The British Association for Sexual Health & HIV (BASHH) guidelines recommend individuals, especially men who have sex with men (MSM), presenting with symptoms consistent with anorectal syndrome, should be investigated for the presence of LGV infection by detection of LGV-specific DNA, performed on specimens confirmed as chlamydia NAAT positive. 6 Current guidelines recommend a full sexual health screen for all individuals diagnosed with one sexually transmitted infection (STI); for asymptomatic MSM, this includes a first void urine sample, a rectal swab and, subsequent to this project's initiation, a pharyngeal swab to test for chlamydia and gonorrhoea infections. 7,8 Further typing of any positive chlamydia samples from asymptomatic MSM may allow identification of a pool of asymptomatic LGV co-infection in MSM newly diagnosed with HIV, syphilis or hepatitis C leading to earlier detection and potentially a reduction in onward transmission, in addition to identifying other infections through partner notification.…”

“…The British Association for Sexual Health & HIV (BASHH) guidelines recommend that individuals, especially men who have sex with men (MSM), presenting with symptoms consistent with anorectal syndrome, should be investigated for the presence of LGV infection by detection of LGV-specific DNA, performed on specimens confirmed as chlamydia nucleic acid amplification test (NAAT) positive. 6…”

Lymphogranuloma venereum proctitis masquerading as inflammatory bowel disease in 12 homosexual men

“…By December 2008, 849 UK cases of LGV had been confirmed 3 . Where full genotyping has been possible, all cases have been confirmed as the L2 serovar of CT 4 . This epidemic has been characterized by a preponderance of proctitis, rather than the classical LGV genital ulcer‐adenopathy syndrome seen in tropical regions and affecting primarily heterosexuals.…”

“…By December 2008, 849 UK cases of LGV had been confirmed. 3 Where full genotyping has been possible, all cases have been confirmed as the L2 serovar of CT. 4 This epidemic has been characterized by a preponderance of proctitis, rather than the classical LGV genital ulcer-adenopathy syndrome seen in tropical regions and affecting primarily heterosexuals. In the UK, LGV proctitis has been detected almost exclusively among men who have sex with men (MSM), many of whom are both HIV-positive and report high risk anal sexual practices with multiple and anonymous partners.…”