P3.138 Increasing Asymptomatic Lymphogranuloma Venereum Infection in the UK: Results from a National Case-Finding Study

Abstract

Background Homosexual men have high rates of anal cancer but an understanding of the epidemiology of HSIL, the presumed precursor, is lacking. We aimed to describe the epidemiology of anal HSIL, and association with human papillomavirus (HPV), in a community-recruited cohort of homosexual men. Methods The Study of the Prevention of Anal Cancer is a threeyear prospective study of anal HPV infection and cancer precursors in homosexual men aged ≥ 35. At each visit all men receive an anal swab for cytology and HPV genotyping (Roche Linear Array), and high resolution anoscopy with biopsy of suspected lesions. Anal HSIL was defined as having either intraepithelial neoplasia grade 2/3 on histology and/or HSIL on cytology. Results 293 men were recruited by December 2012. Median age was 49 and 28.3% were HIV-positive. The baseline prevalence of anal HSIL was 44.6% and 34.8% in the HIV-positive and -negative respectively (p = 0.119). Among those without HSIL at baseline, HSIL incidence was 30.0 and 20.0 per 100 person-years in the HIVpositive and -negative (p = 0.467). Among those with HSIL at baseline, the clearance rate was 37.0 and 44.1 per 100 person-years in the HIV-positive and -negative (p = 0.771). Men who tested HPV16 positive on their anal swab at baseline were more likely to develop incident HSIL (58.1 vs 16.1 per 100 person-years, p = 0.002), and less likely to clear prevalent HSIL (15.9 vs. 65.9 per 100 person-years, p = 0.006). Conclusion Anal HSIL were highly prevalent. Incidence and clearance were common and closely associated with HPV16 status. The high rate of clearance is consistent with the observation that anal HSIL progress to cancer less commonly than do cervical HSIL. The close association of persistence with HPV16 status suggests that HPV testing should be investigated as a means of identifying those with HSIL who are at highest risk of developing cancer. LGV cases (55%) were HIV-positive. Through EPIS STI, 279 male and 2 female cases from additional 6 countries were reported, mainly in capital areas. Symptoms were reported for 132 cases: 105 cases with and 27 without symptoms. EPidEmic of LymPhoGrAnuLomA VEnErEum (LGV) in EuroPE P3.136Proctitis was most commonly reported in men. Among those with known HIV status, 80% were HIV positive. 45% of cases in Spain were in migrants and 20% of the UK cases reported sexual contacts abroad. Conclusions LGV remains to be primarily found in HIV positive MSM. Asymptomatic presentation hampers case detection and screening and routine genotyping among MSM were suggested to reduce further transmission of LGV. Screening practises differ across countries which results in diversity in number and nature of reported cases. Countries reported individual and clustered LGV cases in EPIS STI with more detailed information than in routine surveillance reports to ECDC. Efforts were made to increase European collaboration to get a better understanding of the evolving LGV epidemic in Europe. Background Lubricants (lube) used during receptive anal intercourse (RAI) may affect ...

Highly diverse MLVA-ompA genotypes of rectalChlamydia trachomatisamong men who have sex with men in Brighton, UK and evidence for an HIV-related sexual network

“…While the initial LGV outbreak was characterised by a painful proctitis and, on fewer occasions, an inguinal syndrome, the number of asymptomatic individuals at that time was low. However, the most recent national LGV case-finding exercise found that 22% of LGV cases were asymptomatic, a quarter of those being presymptomatic, that is, men were asymptomatic at first visit but symptomatic by the time they attended for treatment of rectal chlamydia 27. Despite smaller numbers, our data showed an asymptomatic LGV rate of 36%, slightly higher than the national rate but also consistent with the changing epidemiology of LGV.…”

2015 UK national guideline for the management of infection with Chlamydia trachomatis

“…Most cases have occurred in HIV-positive MSM. 55–59 Most patients present with proctitis, 60,61 however, asymptomatic infection may occur 62 (please see BASHH LGV guideline). A recent multicentre study from PHE showed that 26% of patients with LGV were asymptomatic and these asymptomatic patients were more likely to be HIV infected than those with asymptomatic non-LGV chlamydial infection.…”

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

“…Chemsex (specifically the use of GHB), condomless anal sex and fisting are associated with LGV infection (67,130,131). In the UK, the LGV outbreak started in 2003 and the prevalence of asymptomatic infections increased from 6% of serotypes in 2006 to 22% in 2012 (132,133), meaning that LGV in the UK has now entered an endemic phase (134).…”