Prevalence and predictors of Lymphogranuloma venereum in a high risk population attending a STD outpatients clinic in Italy

Abstract

BackgroundWe evaluated LGV prevalence and predictors in a high risk population attending a STI Outpatients Clinic in the North of Italy.MethodsA total of 108 patients (99 MSM and 9 women), with a history of unsafe anal sexual intercourses, were enrolled. Anorectal swabs and urine samples were tested for Chlamydia trachomatis (CT) DNA detection by Versant CT/GC DNA 1.0 Assay (Siemens Healthcare Diagnostics Terrytown, USA). RFLP analysis was used for CT molecular typing.ResultsL2 CT genotype was identified in 13/108 (12%) rectal swabs. All LGV cases were from MSM, declaring high-risk sexual behaviour and complaining anorectal symptoms. Patients first attending the STI Outpatient Clinic received a significant earlier LGV diagnosis than those first seeking care from general practitioners or gastroenterologists (P = 0.0046).LGV prevalence and characteristics found in our population are in agreement with international reports. Statistical analysis showed that LGV positive patients were older (P = 0.0008) and presented more STIs (P = 0.0023) than LGV negative ones, in particular due to syphilis (P < 0.001), HIV (P < 0.001) and HBV (P = 0.001).Multivariate logistic regression analysis revealed that HIV and syphilis infections are strong risk factors for LGV presence (respectively, P = 0.001 and P = 0.010).ConclusionsEven if our results do not provide sufficient evidence to recommend routine screening of anorectal swabs in high-risk population, they strongly suggest to perform CT NAAT tests and genotyping on rectal specimens in presence of ulcerative proctitis in HIV and/or syphilis-positive MSM. In this context, CT DNA detection by Versant CT/GC DNA 1.0 Assay, followed by RFLP analysis for molecular typing demonstrated to be an excellent diagnostic algorithm for LGV identification.

Chlamydia trachomatis infection prevalence and serovar distribution in a high-density urban area in the north of Italy

“…In the present study, the L2 serovar was identified as the most prevalent CT genotype on rectal specimens, and, as previously reported (White, 2009;Foschi et al, 2014), LGV-positive patients were significantly older than LGV-negative ones. In accordance with international data, the L2 serovar was detected only in extra-genital samples from only males belonging to the STI Outpatients Clinic, with no cases of urethral involvement (Ward et al, 2009;Foschi et al, 2014;Heiligenberg et al, 2014;Stoner & Cohen, 2015). Even though recently some cases of urethral LGV in a group of MSM were recorded (de Vrieze et al, 2013) and several cases of LGV in women were reported (Rodriguez-Dominguez et al, 2014), we had no opportunity to detect similar cases.…”

“…As already described, since 2003 (Nieuwenhuis et al, 2004;Foschi et al, 2014) LGV serovars with rectal localization have been found in high-risk populations, mainly in MSM, leading to moderate or severe ulcerative proctitis with various ano-rectal disorders (Martin-Iguacel et al, 2010). In the present study, the L2 serovar was identified as the most prevalent CT genotype on rectal specimens, and, as previously reported (White, 2009;Foschi et al, 2014), LGV-positive patients were significantly older than LGV-negative ones.…”

“…As already described, since 2003 (Nieuwenhuis et al, 2004;Foschi et al, 2014) LGV serovars with rectal localization have been found in high-risk populations, mainly in MSM, leading to moderate or severe ulcerative proctitis with various ano-rectal disorders (Martin-Iguacel et al, 2010). In the present study, the L2 serovar was identified as the most prevalent CT genotype on rectal specimens, and, as previously reported (White, 2009;Foschi et al, 2014), LGV-positive patients were significantly older than LGV-negative ones. In accordance with international data, the L2 serovar was detected only in extra-genital samples from only males belonging to the STI Outpatients Clinic, with no cases of urethral involvement (Ward et al, 2009;Foschi et al, 2014;Heiligenberg et al, 2014;Stoner & Cohen, 2015).…”

“…CT infections are also responsible for trachoma-associated blindness (Derrick et al, 2015) and for lymphogranuloma venereum (LGV), a systemic infection characterized in Western countries by outbreaks of symptomatic ulcerative procto-colitis mainly in MSM (de Vrieze & de Vries, 2014;Foschi et al, 2014).…”

“…In the case of a positive result, the corresponding remaining eluate was recovered from the Versant PCR plate and used for CT molecular genotyping. Molecular genotyping was performed by an omp1 gene semi-nested PCR followed by RFLP analysis as previously described (Gallo Vaulet et al, 2010;Foschi et al, 2014). Briefly, the first product of 1033 bp was amplified using the following paired primers: SERO1A (5¢-ATGAAAAAACTCTGAAATCGG-3¢) and SERO2A (5¢-TTTCTAGATCTTCATTCTTGTT-3¢).…”