Diagnostic and Clinical Implications of Anorectal Lymphogranuloma Venereum in Men Who Have Sex with Men: A Retrospective Case-Control Study

Bij, Akke K. van der; Spaargaren, Joke; Morré, Servaas A.; Fennema, H; Mindel, Adrian; Coutinho, Roel A.; Vries, Henry J. C. de

doi:10.1086/498904

Cited by 163 publications

(145 citation statements)

References 22 publications

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“…In some series there was a significant group with no or few symptoms, which could suggest that the number of cases reported might underestimate the real disease occurrence [37,38].…”

Section: Epidemiologymentioning

confidence: 99%

“…The HIV-1 infection has been identified as the strongest risk factor for anorectal LGV [3,38]. MSM have not been confirmed to be a reservoir of LGV and the high rate of HIV co-infection probably reflects the confounding effect of HIV as a surrogate marker of highrisk behaviour; nevertheless, a potential effect of HIV infection increasing the susceptibility to infection or facilitating the expression of the disease cannot be ruled out [2,[39][40][41].…”

Section: Epidemiologymentioning

confidence: 99%

“…The role of the CD4 cell count in modulating the clinical picture of LGV proctocolitis, as occurs with almost all opportunistic infections associated with HIV, is yet to be elucidated [37]. In a retrospective study no differences in the clinical picture of proctitis investigated by proctoscopy were noted among HIVpositive patients who did or did not receive HAART [38]. However, more than the use of HAART, it would be interesting to examine the clinical presentation stratified by the CD4 count.…”

Section: Clinical Syndromementioning

confidence: 99%

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Lymphogranuloma venereum proctocolitis: a silent endemic disease in men who have sex with men in industrialised countries

Martín-Iguacel

Llibre

Nielsen

et al. 2010

Eur J Clin Microbiol Infect Dis

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Lymphogranuloma venereum (LGV) is a sexually transmitted disease (STD) caused by serovars L1-L3 of Chlamydia trachomatis. Rare in the western world prior to 2003, different outbreaks or clusters of LGV have been reported in Europe, North America and Australia among men who have sex with men (MSM) over the past few years. The majority were HIV infected MSM with high-risk sexual behaviour and a high rate of concomitant STD, including hepatitis C. Most of them presented with a proctitis syndrome and only a few with the classical bubonic form. A previously non-described serovar, L2b, has been identified as the main causative agent of the epidemic. A delay in diagnosis has been the rule because of the misleading symptomatology of LGV proctitis, the unfamiliarity of the disease to physicians, and the lack of a routine diagnostic test for LGV serovars. It is crucial to increase the awareness of the disease among physicians for prompt diagnosis and treatment, to avoid complications, and to stop ongoing transmission. It has additional public health implications since LGV may facilitate the transmission and acquisition of HIV and other STD.

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“…In some series there was a significant group with no or few symptoms, which could suggest that the number of cases reported might underestimate the real disease occurrence [37,38].…”

Section: Epidemiologymentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

Section: Clinical Syndromementioning

confidence: 99%

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Lymphogranuloma venereum proctocolitis: a silent endemic disease in men who have sex with men in industrialised countries

Martín-Iguacel

Llibre

Nielsen

et al. 2010

Eur J Clin Microbiol Infect Dis

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“…21,22 Nonetheless, a low titre does not exclude LGV, nor does a high titre in a patient without LGV symptomatology confirm LGV infection. 10,11 (III, B) The identification of rectal polymorphonuclear leucocytes from rectal swabs is predictive of LGV proctitis, especially in HIV-positive MSM, with levels greater than 10 cells per high power field. …”

Section: Clinical Featuresmentioning

confidence: 99%

2013 European guideline on the management of lymphogranuloma venereum

Vries

Zingoni

Kreuter

et al. 2014

Acad Dermatol Venereol

117

110

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What is new in this updated guideline?This is the update version of the 2010 European guideline on the management of lymphogranuloma venereum (LGV). New issues are:Epidemiology 1 Based on clonal relatedness of prevalent LGV strains there is evidence that the LGV epidemic among men who have sex with men (MSM) in the Western world prevailed already in the United States in the 1980s and was introduced into Europe by the end of the last century. Aetiology and transmission1 A new LGV variant causing severe proctitis was unveiled and designated L2c. 2 The L2b LGV variant causing the vast majority of infections among MSM is now also found among a few heterosexual women. Management1 Apart from HIV and STI screening, Hepatitis C Virus (HCV) testing should be offered to all LGV patients. 2 To exclude reinfections, STI screening during a follow-up visit 3 months after an LGV diagnosis should be offered. Conflicts of interestNone declared. Funding sourcesNone declared. Lymphogranuloma venereum (LGV) EpidemiologyThe LGV has re-emerged among European men who have sex with men (MSM) in the past decade 1 and is probably endemic in this population where it is a relatively common cause of proctitis and occasional genital ulcer-adenopathy disease.LGV among MSM in Europe is caused in the majority of cases by the Chlamydia trachomatis biovar L2b which shows a high degree of clonal relatedness as found by Multi Locus Sequence Typing in a

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“…Adataink szerint az alacsony abszolút CD4-pozitív T-lymphocyta-szám nem feltétele a fertőzés akvirációjának. ART-terápiában részesülő, illetve nem részesülő betegeket összehasonlítva az LGV-fertőzés incidenciájában nem találtak eltérést [25]. Általá-nosságban jellemző a betegekre, mint eseteinkben is láthattuk, a rossz compliance.…”

Section: Esetismertetésunclassified

Lymphogranuloma venereum – the first Hungarian cases

et al. 2015

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A lymphogranuloma venereum a Chlamydia trachomatis L1-3 szerovariánsa által terjesztett nemi betegség, amely korábban elsősorban a trópusi éghajlatú országokban volt elterjedt. Az elmúlt évtizedekben Nyugat-Európában szá-mos esetet jelentettek, elsősorban a humán immundefi cientia vírus fertőzött homoszexuális férfi populációban. A szerzők intézetében 2013-ban két esetet, 2014-ben egy esetet diagnosztizáltak. A szerzők e három humán immundefi cientia vírus fertőzött homoszexuális férfi kórtörténetét ismertetik, akik nyugat-európai tartózkodásuk alatti alkalmi kapcsolatok során fertőződtek meg. Két esetben urethralis fl uor, diszkomfort és inguinalis lymphadenomegalia, egy esetben analis diszkomfort, illetve perianalis ulceratio volt a vezető klinikai tünet. Az urethralis váladékból, illetve a perianalis ulcus váladékából végzett célzott real-time polimeráz láncreakció vizsgálat eredménye két esetben lymphogranuloma venereum L2b, egy esetben L2 szerovariánst igazolt. Doxycyclinkezelést követően a betegek gyógyul-tak. A lymphogranuloma venereum a jövőben vélhetően fokozódó kihívást jelent, így ismerete számos szakterületen fontos a késői szövődmények megelőzése és a kórkép további terjedésének megállítása céljából. Orv. Hetil., 2015, 156(1), 36-40. Kulcsszavak: lymphogranuloma venereum, Chlamydia trachomatis, HIV, MSM Lymphogranuloma venereum -the fi rst Hungarian casesLymphogranuloma venereum is a sexually transmitted infection caused by the Chlamydia trachomatis serovars L1-3. It has been found to be endemic in tropical countries. In the last decades several cases have been reported in Western Europe, particularly in men who have sex with men population infected with human immunodefi ciency virus. The authors present three cases of lymphogranuloma venereum infections, observed at their department in 2013 and 2014. The three human immunodefi ciency virus infected patients who belonged to men who have sex with men population had casual sexual contacts in Western Europe. The symptoms included urethral discharge, discomfort and inguinal lymphadenomegaly in two patients, and rectal pain, discharge and perianal ulceration in one patient. The diagnosis was confi rmed by nucleic acid amplifi cation test performed in samples obtained from urethral discharge and exudate of perianal ulcer; lymphogranuloma venereum 2b serovars were demonstrated in two patients and serovar 2 in one patient. Doxycyclin (daily dose of two times 100 mg for 21 days) resolved the symptoms in all cases. The authors conclude that lymphogranuloma venereum is a diagnostic challenge in Hungary, too. It is important to be aware of the altered clinical features of this disease to prevent complications and spreading.

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Diagnostic and Clinical Implications of Anorectal Lymphogranuloma Venereum in Men Who Have Sex with Men: A Retrospective Case-Control Study

Cited by 163 publications

References 22 publications

Lymphogranuloma venereum proctocolitis: a silent endemic disease in men who have sex with men in industrialised countries

Lymphogranuloma venereum proctocolitis: a silent endemic disease in men who have sex with men in industrialised countries

2013 European guideline on the management of lymphogranuloma venereum

Lymphogranuloma venereum – the first Hungarian cases

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