Observational study of anorectal Chlamydia trachomatis infections in France through the lymphogranuloma venereum surveillance network, 2010–2015

Abstract

The objective of this article is to describe the epidemiology of lymphogranuloma venereum (LGV) and non-LGV Chlamydia trachomatis anorectal infections in France and to examine the characteristics of the affected populations via a voluntary sentinel surveillance system for LGV between 2010 and 2015. Anorectal samples positive for C. trachomatis (CT) were sent by the participating laboratories to the National Reference Center for CT for LGV identification. Biological and clinical data were collected by biologists and clinicians. There were 1740 LGV episodes and 2248 non-LGV episodes. Continuous monitoring highlighted a sharp increase in the number of LGV and non-LGV anorectal infections, which were 2.3-fold and 6.5-fold, respectively. Most of the infections occurred in men who have sex with men. LGV patients were older than non-LGV patients and were more frequently human immunodeficiency virus (HIV)-positive compared to non-LGV patients. Anorectal LGV was significantly associated with residence in Paris, HIV co-infection, concurrent syphilis and bloody anal discharge. Undocumented patient characteristics were strongly associated with anorectal LGV. The anorectal LGV epidemic is poorly controlled in France. Early detection and prompt treatment of patients and their sexual partners are required to prevent transmission in the context of pre-exposure prophylaxis (PrEP) for HIV infection.

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

“…Outbreak investigations and surveillance data consistently showed that the majority of LGV cases occurred among HIV-positive MSM and that most of the cases presented with proctitis [2,4]. In contrast to previous reports showing that this profile of individuals with LGV has remained largely unchanged over the years, we found increasing proportions of HIVnegative and asymptomatic MSM among LGV-positives, up to almost 50% in 2017 [2,13,19,20].…”

“…In the Netherlands, the increasing number of LGV infections coincided with increasing numbers and positivity rates of gonorrhoea and infectious syphilis [17]. A rising trend in the number of LGV infections was also observed in France, which was explained by a combination of improved surveillance, better access to testing and an increasing incidence possibly due to increases in condomless anal sex among MSM [19]. Outbreak investigations and surveillance data consistently showed that the majority of LGV cases occurred among HIV-positive MSM and that most of the cases presented with proctitis [2,4].…”

2019 European guideline on the management of lymphogranuloma venereum

“… The prevalence of HIV among MSM with LGV ranges from 67% to 100% in 13 descriptive studies. There is a significant association between HIV and LGV (odds ratio, 8.19, 95% CI, 4.68–14.33) (1,A) . Moreover, hepatitis C is associated with LGV in the current epidemic among MSM …”

Delayed diagnosis of lymphogranuloma venereum in a hospital setting – a retrospective observational study

“…11 The same trend has recently been described in the United Kingdom 12 , Belgium 13 , Spain 14 and France. 15 In addition, the rising use of pre-exposure prophylaxis amongst MSM might be associated with more high-risk sexual behaviour and a subsequent increase of STIs. 16 As a result of this trend, a wide variety of medical specialists may encounter patients with LGV–related symptoms.…”