Update on lymphogranuloma venereum in the United Kingdom

Jebbari, Heather; Alexander, Sarah; Ward, Helen; Evans, B A; Solomou, Maria; Thornton, Alicia; Dean, G; White, John Albert; French, Patrick; Ison, Catherine

doi:10.1136/sti.2007.026740

Cited by 53 publications

(82 citation statements)

References 12 publications

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“…Subsequently, a cluster of 13 MSM with LGV serovar L2 was detected through contact tracing [3], most of whom were HIVpositive. They presented with a median duration of 3 months of unspecific intestinal symptoms and 46% had another concomitant STD [1][2][3][4][5][6][7][8][9][10]. Several outbreaks in MSM have so far been reported in Western Europe, Australia and the USA, clustering in large cities [2,[4][5][6][7][8][9][10][11][12][13][14][15][27][28][29][30][31][32].…”

Section: Epidemiologymentioning

confidence: 99%

“…In 2003 a cluster of LGV with a new strain, L2b, was detected in Rotterdam, the Netherlands, among men who have sex with men (MSM) presenting mainly as proctitis [3]. Since then many countries all across Europe, North America and Australia have reported clusters of cases in sexual networks of MSM with a total of over 1,600 cases of proctitis reported so far [1,2,[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”

Section: Introductionmentioning

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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Section: Epidemiologymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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“…Epidemiological and behavioural data on 423 cases detected between October 2004 and the end of April 2007 showed LGV in the UK follows a similar pattern to Europe: cases are found predominantly among homosexual men of white ethnicity who are often coinfected with HIV (78%) and other STIs including hepatitis C, gonorrhoea, and syphilis. 2 Cases have been distributed widely across the UK, but the highest number has been seen in London and Brighton. Most cases of LGV have been symptomatic, usually presenting with proctitis, with a few cases as contacts.…”

Section: Epidemiologymentioning

confidence: 99%

“…1,2 Following the recognition of a large number of cases of LGV proctitis among homosexual men in the Netherlands in 2004, 3 an epidemic is now well established in the UK, 2,4 Western Europe and the USA. Thus far, the infection has been confined almost exclusively to the homosexual male population, especially those coinfected with HIV, 2 hepatitis C 5 and other STIs, most cases presenting with severe proctitis.…”

mentioning

confidence: 99%

“…Even inguinogenital manifestations of LGV such as buboes and genital ulcers, usually seen in regions of the world where LGV is endemic, are beginning to be recognised. 2 Prompt antibiotic treatment is effective and curative, yet broader awareness among a wide range of clinicians is needed to enable appropriate investigation and management and the interruption of onward spread.…”

mentioning

confidence: 99%

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Lymphogranuloma venereum: what does the clinician need to know?

White

Ison

2008

Clinical Medicine

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Lymphogranuloma venereum: what does the clinician need to know? Rectal biopsy showed severe non-specific inflammation and the patient was treated empirically with steroid suppositories for possible irritable bowel disease. Following genitourinary medicine review, a rectal swab specimen tested positive for Chlamydia trachomatis, subsequently typed as the L2 strain. Symptoms abated completely after three weeks' treatment with doxycycline.syndrome including anogenital ulceration and buboes (Fig 3). Less common presentations have been described such as urethritis 6 and bubonulus 7 (primary stage of disease with large tender lymphangial nodule and lymphangitis of dorsal penis). Asymptomatic rectal infections have been detected only rarely within a large casefinding exercise in the UK, suggesting that a large reservoir of 'silent' infection is unlikely. 8 Differential diagnosisThe differential diagnosis of proctitis among homosexual men includes rectal gonorrhoea, which is usually less severe clinically and often asymptomatic. Anorectal herpes simplex virus-1 or -2 infection, especially if a primary infection, can cause severe anorectal pain often out of proportion to other proctitis symptoms and may also cause regional neurological symptoms including urinary retention and constipation. Non-LGV rectal C. trachomatis infection caused by serovars D-K is usually asymptomatic but can occasionally show clinical features of overt proctitis. Syphilis infection is on the rise again among homosexual men, and in its role as 'the great imitator' can cause clinical proctitis.Excellent clinical and microbiological responses have been observed in LGV infection with the recommended treatment of oral doxycycline 100 mg bid for three weeks. 9,10 Laboratory diagnosisThe Detection of lymphogranuloma venereum in rectal specimensIn October 2004, the Sexually Transmitted Bacteria Reference Laboratory (STBRL) at the Health Protection Agency (HPA) Centre for Infections established a testing algorithm for the detection of LGV in rectal specimens. This includes confirmation of the presence of C. trachomatis using a real-time polymerase chain reaction (RT-PCR) that uses primers different from any commercial assay. 11 Residual samples from both NAATs and EIAs or dry swabs can be tested. Any specimens giving a negative result are confirmed using the Qiagen RT-PCR (which is not used extensively in the UK) and a report issued. All samples confirmed to contain C. trachomatis-specific DNA are then tested to determine whether this belongs to an LGV serovar (L1, L2 or L3), using an RT-PCR which detects a deletion in the pmp gene present only in L-serovars of C. trachomatis. 12 This test gives a positive result for LGV-associated serovars and a negative result for other serovars and provides a timely result allowing a positive report to be issued. All positive specimens are then confirmed using a nested PCR that amplifies the omp1 gene which is present in single copy, followed by digestion with restriction endonucleases. 13,14 The pattern obtained is ...

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Bacterial Infections

Adriaans

2010

Rook's Textbook of Dermatology

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Update on lymphogranuloma venereum in the United Kingdom

Cited by 53 publications

References 12 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

Lymphogranuloma venereum: what does the clinician need to know?

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