Changing Pattern of<i>Chlamydia trachomatis</i>Strains in Lymphogranuloma Venereum Outbreak, France, 2010–2015

Peuchant, Olivia; Touati, Arabella; Sperandio, Clément; Hénin, Nadège; Laurier-Nadalié, Cécile; Bebear, Cécile; Barbeyrac, Bertille de

doi:10.3201/eid2211.160247

Cited by 46 publications

(47 citation statements)

References 14 publications

(13 reference statements)

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“…In accordance with a previous study,23 we found that the L2b ompA variant was not the most common in the pooled data set5 24; the L2 ompA sequence predominated. However, this varied by country as the L2 ompA sequence predominated in Austria, while the L2b omp A sequence predominated in the UK.…”

Section: Discussionsupporting

confidence: 93%

“…However, this varied by country as the L2 ompA sequence predominated in Austria, while the L2b omp A sequence predominated in the UK. We also observed more ompA sequence diversity23 25 than previously reported 5 24. This diversity may be due to more mixed infections and subsequent recombination, sampling from different MSM sexual networks, or the occurrence of single nucleotide polymorphisms through mutations over time.…”

Section: Discussionsupporting

confidence: 41%

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Substantial underdiagnosis of lymphogranuloma venereum in men who have sex with men in Europe: preliminary findings from a multicentre surveillance pilot

et al. 2019

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ObjectivesUnderstanding the public health impact of lymphogranuloma venereum (LGV) in Europe is hampered by inadequate diagnostics and surveillance systems in many European countries. We developed and piloted LGV surveillance in three European countries without existing systems and performed a preliminary investigation of LGV epidemiology, where little evidence currently exists.MethodsWe recruited STI or dermatovenereology clinics and associated laboratories serving men who have sex with men (MSM) in Austria, Croatia and Slovenia, using the UK for comparison. We undertook centralised LGV testing of Chlamydia trachomatis (CT)-positive rectal swabs collected between October 2016 and May 2017 from MSM attending these clinics. Stored specimens from Austria (2015–2016) and Croatia (2014) were also tested. Clinical and sociodemographic data were collected using a standardised proforma. The ompA gene of LGV-positive specimens was sequenced.ResultsIn total, 500 specimens from CT-positive MSM were tested, and LGV positivity was 25.6% (128/500; 95% CI 22.0% to 29.6%) overall, and 47.6% (79/166; 40.1% to 55.2%) in Austria, 20.0% (3/15; 7.1% to 45.2%) in Croatia, 16.7% (1/6; 3.0% to 56.4%) in Slovenia and 14.4% (45/313; 10.9% to 18.7 %) in the UK. Proformas were completed for cases in Croatia, Slovenia and in the UK; proformas could not be completed for Austrian cases, but limited data were available from line listings. Where recorded, 83.9% (78/93) of LGV-CT cases were HIV-positive compared with 65.4% (149/228) of non-LGV-CT cases; MSM with LGV-CT were more likely to have proctitis (Austria, 91.8% vs 40.5%, p<0.001; Croatia, 100% vs 25%, p=0.04; UK, 52.4% vs 11.7%, p<0.001) than those with non-LGV-CT. Six different ompA sequences were identified, including three new variants; the L2 ompA sequence predominated (58.6%, 51/87).ConclusionsLGV is substantially underdiagnosed in MSM across Europe. Unified efforts are needed to overcome barriers to testing, establish effective surveillance, and optimise diagnosis, treatment and prevention.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 41%

Substantial underdiagnosis of lymphogranuloma venereum in men who have sex with men in Europe: preliminary findings from a multicentre surveillance pilot

et al. 2019

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“…Thus, the change in testing policy may not be the sole explanation. A hypothetical explanation could be a change in circulating LGV strains over time, as observed in France where the predominating strain changed from L2b to L2 between 2010 and 2015 [23]. Although not supported by French data, less severe clinical features or no symptoms have been observed among patients infected with the L2 strain compared with patients infected with the L2b strain in Spain [24].…”

Section: Discussionmentioning

confidence: 92%

Increasing trends of lymphogranuloma venereum among HIV-negative and asymptomatic men who have sex with men, the Netherlands, 2011 to 2017

Aar

Kroone

Vries³

et al. 2020

Eurosurveillance

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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. 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. Aim: We investigated LGV trends among MSM attending Centres for Sexual Health using surveillance data between 2011 and 2017. Methods: LGV 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. Results: We included 224,194 consultations. LGV increased from 86 in 2011 to 270 in 2017. Among LGVpositives, 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 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. Multivariable models showed increased odds ratios and significant positive associations between years and LGV. Conclusions: Although 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.

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“…These were designated L2bV1 according to a recent article [15]. The sequencing of one isolate failed in spite of repeated attempts because of low copy number of DNA.…”

Section: Resultsmentioning

confidence: 99%

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

2017

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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.

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Changing Pattern ofChlamydia trachomatisStrains in Lymphogranuloma Venereum Outbreak, France, 2010–2015

Cited by 46 publications

References 14 publications

Substantial underdiagnosis of lymphogranuloma venereum in men who have sex with men in Europe: preliminary findings from a multicentre surveillance pilot

Substantial underdiagnosis of lymphogranuloma venereum in men who have sex with men in Europe: preliminary findings from a multicentre surveillance pilot

Increasing trends of lymphogranuloma venereum among HIV-negative and asymptomatic men who have sex with men, the Netherlands, 2011 to 2017

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

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