The use of serological titres of IgA and IgG in (early) discrimination between rectal infection with non-lymphogranuloma venereum and lymphogranuloma venereum serovars of Chlamydia trachomatis

Abstract

An increased IgA antibody response and the age of the infected individual are of possible diagnostic value for (early) detection of LGV proctitis.

Are serological chlamydia-specific markers useful to detect asymptomatic cases of lymphogranuloma venereum proctitis?

“…As published previously, and also mentioned in the article by van der Snoek et al ,4 a considerable number of the patients with LGV proctitis in the present epidemic are asymptomatic 2 5. In a retrospective case–control study2 we found that only 47% of LGV cases had signs of proctitis (mucous membrane abnormalities) upon proctoscopic examination.…”

“…In a recent interesting study, van der Snoek et al 4 concluded that an elevated Chlamydia trachomatis IgA antibody response and the age of the infected individual are of possible diagnostic value for the early detection of LGV proctitis. Based on their study of 24 MSM with L2 proctitis and 15 MSM with rectal C. trachomatis (non-LGV) infection, the authors suggest that the association between LGV L2 and significantly higher titres of IgA and IgG are caused by more invasive and more chronic inflammation of the proctum caused by the LGV biovar.…”

“…In a retrospective case–control study2 we found that only 47% of LGV cases had signs of proctitis (mucous membrane abnormalities) upon proctoscopic examination. Unfortunately, the paper by van der Snoek et al 4 failed to inform its readers about the patient complaints and/or clinical symptoms found among the patients included. Their recommendation to test IgA levels in high-risk populations to exclude LGV might therefore possibly miss a considerable number of asymptomatic cases of LGV proctitis, with consequences for both the individual patient and the population at risk.…”

Surveillance of sexually transmitted infections among persons living with HIV

“…Some cases classified as possible or probable LGV could be non-LGV associated C. trachomatis serovars. Nevertheless, invasive titers, used as a diagnostic criterion in our study, were found of possible diagnostic value for LGV proctitis in another study (Van der Snoek et al 2008). An LGV outbreak among MSM has already been observed in at least 11 European countries (Timen et al 2008).…”

2013 European guideline on the management of lymphogranuloma venereum

“…IgA anti-MOMP antibodies) in a patient with a clinical syndrome suggestive of LGV supports the diagnosis. 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.…”