Clinical and epidemiological characterization of a lymphogranuloma venereum outbreak in Madrid, Spain: co-circulation of two variants

Abstract

The lymphogranuloma venereum (LGV) outbreak described in the Netherlands in 2003, increased the interest in the genotyping of Chlamydia trachomatis. Although international surveillance programmes were implemented, these studies slowly decreased in the following years. Now data have revealed a new accumulation of LGV cases in those European countries with extended surveillance programmes. Between March 2009 and November 2011, a study was carried out to detect LGV cases in Madrid. The study was based on screening of C. trachomatis using commercial kits, followed by real-time pmpH-PCR discriminating LGV strains, and finally ompA gene was sequenced for phylogenetic reconstruction. Ninety-four LGV infections were identified. The number of cases increased from 10 to 30 and then to 54 during 2009-2011. Incidence of LGV was strongly associated with men who have sex with men; but in 2011, LGV cases were described in women and heterosexual men. Sixty-nine patients were also human immunodeficiency virus (HIV) positive, with detectable viral loads at the moment of LGV diagnosis, suggesting a high-risk of co-transmission. In fact, in four patients the diagnosis of HIV was simultaneous with LGV infection. The conventional treatment with doxycycline was prescribed in 75 patients, although in three patients the treatment failed. The sequencing of the ompA gene permitted identification of two independent transmission nodes. One constituted by 25 sequences identical to the L2b variant, and a second node including 37 sequences identical to L2. This epidemiological situation characterized by the co-circulation of two LGV variants has not been previously described, reinforcing the need for screening and genotyping of LGV strains.

Clinical and epidemiological characterisation of lymphogranuloma venereum in southwest Spain, 2013–2015

“…In this study, we described 13 cases of LGV (2.2% of all C. trachomatis infections detected and 7.8% of those detected in MSM), all with the same variant (L2b) described previously in Europe 4–5 8. About 85% were HIV positive higher than previously reported in Spain5 and over a third were asymptomatic similar to a recently published UK study 9…”

“…The consensus sequences were compared with known C. trachomatis LGV strains by using the BLAST search tool (http://www.ncbi.nlm.nih.gov), including LGV variants previously described in Spain 5. Sequences were edited with Chromas Lite 2.1.1 software and aligned using Clustal Omega by manual editing.…”

“…In Spain, cities such as Barcelona and Madrid have detected an increase in LGV diagnoses of ∼115% from 2009 to 2011,4 and a recent outbreak, respectively 5. Unfortunately, many laboratories worldwide still do not have genetic tools to detect and identify LGV serovars.…”

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

“…The implication of pharyngeal as well as urethral LGV in transmission of the epidemic strain remains unclear. Rectal infections have been shown to be far more common in various LGV prevalence studies (23)(24)(25)(26). It is thus arguable that extrarectal screening would not be a cost-effective measure.…”

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

“…Almost all LGV cases have been caused by the C. trachomatis L2b variant, which harbors an A/G substitution on the omp A gene at position 485, suggesting a single source of origin for the outbreaks ( 6 , 7 ). Recently, however, 2 C. trachomatis variants co-circulated during an LGV epidemic in Spain ( 8 ). The objective of this study was to investigate if genetic variations exist within LGV C. trachomatis strains circulating in France during 2010–2015 by sequencing of the omp A gene.…”