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Chromy D, Sadoghi B, Gasslitter I, Skocic M, Okoro A, Grabmeier-Pfistershammer K, Willinger B, Weninger W, Öllinger A, Sarcletti M, Stary G, Bauer WM. Lymphogranuloma venereum verläuft häufig asymptomatisch bei Männern, die Sex mit Männern haben, in Österreich. J Dtsch Dermatol Ges 2024; 22:389-398. [PMID: 38450885 DOI: 10.1111/ddg.15329_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 11/14/2023] [Indexed: 03/08/2024]
Abstract
ZusammenfassungHintergrund und ZieleLymphogranuloma venereum (LGV) ist eine sexuell übertragene Erkrankung verursacht durch Chlamydia trachomatis (CT), Serovar L1–L3. Eine Zunahme von LGV ist vorwiegend bei Männern, die Sex mit Männern haben (MSM), beobachtet worden. Die Unterscheidung zwischen LGV und Nicht‐LGV‐Serovaren hat therapeutische Konsequenzen, daher wurden Prävalenz und Charakteristika von LGV innerhalb aller CT‐Infektionen untersucht.Patienten und MethodikAlle CT‐positiven Befunde, erhoben an den vier größten österreichischen HIV‐ und STI‐Kliniken von 04/2014–12/2021, wurden hinsichtlich Charakteristika der Erkrankung und Demographie der Patienten ausgewertet.ErgebnisseInsgesamt wurden n = 2083 CT‐Infektionen bei n = 1479 Personen dokumentiert. Das mediane Alter betrug 31,4 Jahre, 81% waren männlich, 59% MSM, 44% HIV‐positiv, 13% nutzten HIV‐Prä‐Expositionsprophylaxe. Serovaranalysen waren bei 61% (1258/2083) verfügbar, wobei L1–L3 in 15% (192/1258) aller Fälle nachgewiesen wurde. Bei MSM mit rektaler CT‐Infektion waren 23% (101/439) LGV. LGV‐Fälle verglichen mit CT‐Infektionen traten vermehrt bei MSM (92% [177/192] vs. 62% [1179/1891], p < 0,001), HIV‐Positivität (64% [116/180] vs. 46% [631/1376]; p < 0,001) und konkomitanter Syphilisinfektion (18% [32/180] vs. 7% [52/749]; p < 0,001) auf. LGV‐Infektionen verliefen zumeist asymptomatisch (45% [87/192]), gefolgt von Proktitis (38% [72/192]).SchlussfolgerungenLymphogranuloma venereum machte 23% der rektalen CT‐Infektionen bei MSM aus und 45% aller LGV‐Fälle waren asymptomatisch. Bei fehlender CT‐Serovar‐Analyse sollte in Risikopopulationen eine erhöhte LGV‐Prävalenz in Betracht gezogen und bei der empirischen Therapiedauer berücksichtigt werden.
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Affiliation(s)
- David Chromy
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Birgit Sadoghi
- Universitätsklinik für Dermatologie, Venerologie, Medizinische Universität Graz, Graz, Österreich
| | - Irina Gasslitter
- Universitätsklinik für Dermatologie, Venerologie und Allergologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Mattias Skocic
- Universitätsklinik für Dermatologie und Venerologie, Kepler Universitätsklinikum, Linz, Österreich
| | - Anthony Okoro
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | | | - Birgit Willinger
- Abteilung für Klinische Mikrobiologie, Klinisches Institut für Labormedizin, Medizinische Universität Wien, Wien, Österreich
| | - Wolfgang Weninger
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Angela Öllinger
- Universitätsklinik für Dermatologie und Venerologie, Kepler Universitätsklinikum, Linz, Österreich
| | - Mario Sarcletti
- Universitätsklinik für Dermatologie, Venerologie und Allergologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Georg Stary
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
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Chromy D, Sadoghi B, Gasslitter I, Skocic M, Okoro A, Grabmeier-Pfistershammer K, Willinger B, Weninger W, Öllinger A, Sarcletti M, Stary G, Bauer WM. Asymptomatic lymphogranuloma venereum is commonly found among men who have sex with men in Austria. J Dtsch Dermatol Ges 2024; 22:389-397. [PMID: 38308171 DOI: 10.1111/ddg.15329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 11/14/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND AND OBJECTIVES Serovar L1-L3 of Chlamydia trachomatis (CT) causes lymphogranuloma venereum (LGV). A surge in LGV-cases has been observed among HIV-positive men who have sex with men (MSM). Discrimination between LGV and non-LGV is pivotal since it has major treatment implications. Here, we aimed to determine the prevalence and characteristics of LGV among CT-infections. PATIENTS AND METHODS All CT-positive results from 04/2014-12/2021 at the four largest Austrian HIV and STI clinics were evaluated. Disease characteristics and patient demographics were analyzed. RESULTS Overall, n = 2,083 infections of CT were documented in n = 1,479 individual patients: median age was 31.4 years, 81% were male, 59% MSM, 44% HIV-positive, 13% on HIV pre-exposure-prophylaxis. Available serovar analyses (61% [1,258/2,083]) showed L1-L3 in 15% (192/1,258). Considering only MSM with rectal CT-infection, LGV accounted for 23% (101/439). Cases of LGV vs. other CT-infections were primarily MSM (92% [177/192] vs. 62% [1,179/1,891], p < 0.001), more often HIV-positive (64% [116/180] vs. 46% [631/1,376]; p < 0.001) and had frequently concomitant syphilis infection (18% [32/180] vs. 7% [52/749]; p < 0.001). LGV commonly manifested as proctitis (38% [72/192]) whereas 45% (87/192) were asymptomatic. CONCLUSIONS Lymphogranuloma venereum accounted for 23% of rectal CT-infections in MSM. Furthermore, 45% of all LGV-cases were asymptomatic. In the absence of CT-serovar analysis, a high LGV prevalence should be considered in risk-populations and guide empiric treatment selection.
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Affiliation(s)
- David Chromy
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Birgit Sadoghi
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Irina Gasslitter
- Dermatology, Venereology and Allergy, Medical University of Innsbruck, Innsbruck, Austria
| | - Mattias Skocic
- Department of Dermatology, Kepler University Hospital Linz, Linz, Austria
| | - Anthony Okoro
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Birgit Willinger
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Weninger
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Angela Öllinger
- Department of Dermatology, Kepler University Hospital Linz, Linz, Austria
| | - Mario Sarcletti
- Dermatology, Venereology and Allergy, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Stary
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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Martínez-García L, Orviz E, González-Alba JM, Comunión A, Puerta T, Mateo M, Sánchez-Conde M, Rodríguez-Jiménez MC, Rodríguez-Domínguez M, Bru-Gorraiz FJ, del Romero J, Cantón R, Galán JC. Rapid expansion of lymphogranuloma venereum infections with fast diversification and spread of Chlamydia trachomatis L genovariants. Microbiol Spectr 2024; 12:e0285523. [PMID: 38095475 PMCID: PMC10783107 DOI: 10.1128/spectrum.02855-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/22/2023] [Indexed: 01/13/2024] Open
Abstract
IMPORTANCE Numerous international organizations, including the World Health Organization, have been drawing attention to the global increase in sexually transmitted infections. Twenty years ago, lymphogranuloma venereum (LGV) was mainly considered a tropical disease; in recent decades, however, LGV has been increasingly present in high-income countries. This increase has been linked to men who have sex with men who participate in highly interconnected sexual networks, leading to a rapid spread of LGV. This study focuses on the spread of LGV, presenting the largest time series of LGV prevalence in Spain, which includes more than a thousand diagnosed cases in one large city. The number of LGV cases diagnosed was analyzed over time, and a selection of strains was subjected to molecular genotyping. The results indicate that the LGV epidemic is gradually evolving toward an increasingly complex diversification due to the selection of successful genovariants that have emerged by mutation and recombination events, suggesting that we are moving toward an unpredictable scenario.
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Affiliation(s)
- Laura Martínez-García
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Eva Orviz
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - José María González-Alba
- Servicio de Microbiología, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | | | - Teresa Puerta
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - María Mateo
- Servicio de Microbiología, Hospital Central de la Defensa Gómez-Ulla, Madrid, Spain
| | - Matilde Sánchez-Conde
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - María Concepción Rodríguez-Jiménez
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Mario Rodríguez-Domínguez
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Jorge del Romero
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Rafael Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Juan Carlos Galán
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Richardson D, Pakianathan M, Ewens M, Mitchell H, Mohammed H, Wiseman E, Tweed M, Nichols K, Rawdah W, Cooper R, Macrowan R, Irish M, Evans A, Godbole G. British Association of Sexual Health and HIV (BASHH) United Kingdom national guideline for the management of sexually transmitted enteric infections 2023. Int J STD AIDS 2023:9564624231168217. [PMID: 37247427 DOI: 10.1177/09564624231168217] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This is the first British Association of Sexual Health and HIV (BASHH) national guideline for the management of sexually transmitted enteric infections (STEI). This guideline is primarily aimed for level 3 sexual health clinics; however, it may also be applicable to other settings such as primary care or other hospital departments where individuals with STEI may present. This guideline makes recommendations on testing, management, partner notification and public health control of STEI.
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Affiliation(s)
- Daniel Richardson
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Brighton & Sussex Medical School, Brighton, UK
| | | | | | | | | | | | | | | | - Waseem Rawdah
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Richard Cooper
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | | | - Amy Evans
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Hocking JS, Geisler WM, Kong FYS. Update on the Epidemiology, Screening, and Management of Chlamydia trachomatis Infection. Infect Dis Clin North Am 2023; 37:267-288. [PMID: 37005162 DOI: 10.1016/j.idc.2023.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Chlamydia trachomatis infection ("chlamydia") is the most commonly diagnosed bacterial sexually transmitted infection globally, occurring in the genitals (urethra or vagina/cervix), rectum, or pharynx. If left untreated in women, genital chlamydia can ascend into the upper genital tract causing pelvic inflammatory disease, increasing their risk for ectopic pregnancy, infertility, and chronic pelvic pain. In men, chlamydia can cause epididymitis and proctitis. However, chlamydia is asymptomatic in over 80% of cases. This article provides an update on the epidemiology, natural history, and clinical manifestations of chlamydia in adults and discusses the current approaches to its management and control policy.
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Affiliation(s)
- Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, 3/207 Bouverie Street, Carlton South, Melbourne, Victoria, Australia 3053.
| | - William M Geisler
- Department of Medicine, University of Alabama at Birmingham, 703 19th Street South, ZRB 242, Birmingham, AL 35294, USA
| | - Fabian Y S Kong
- Melbourne School of Population and Global Health, University of Melbourne, 3/207 Bouverie Street, Carlton South, Melbourne, Victoria, Australia 3053
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Prazuck T, Lanotte P, Le Moal G, Hocqueloux L, Sunder S, Catroux M, Garcia M, Perfezou P, Gras G, Plouzeau C, Lévêque N, Beby-Defaux A. Pooling Rectal, Pharyngeal, and Urine Samples to Detect Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma genitalium Using Multiplex Polymerase Chain Reaction Is as Effective as Single-Site Testing for Men Who Have Sex With Men. Open Forum Infect Dis 2022; 9:ofac496. [PMID: 36324326 PMCID: PMC9620425 DOI: 10.1093/ofid/ofac496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Indexed: 11/06/2022] Open
Abstract
Background Screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) at pharyngeal, urogenital, and anorectal sites is recommended for men who have sex with men (MSM). Pooling samples is a promising technique, but no data are available when pooled screening also includes Mycoplasma genitalium (MG). The main objective of this study was to examine the sensitivity of pooled samples for detecting CT, NG, and MG in MSM using nucleic acid amplification versus single-site testing. Methods In this multicenter study, MSM with a positive result for CT, NG, or MG were recalled to the clinic for treatment and were asked to participate in this study. Separate samples were sent to a central virological department that proceeded to form the pooled samples. Testing was performed using the multiplex real-time polymerase chain reaction Allplex STI Essential Assay (Seegene, Seoul, Korea), which can simultaneously detect 7 pathogens. Results A total of 130 MSM with at least 1 positive test for CT, NG, or MG were included. A total of 25.4% had a coinfection. The sensitivities of pooled-sample testing were 94.8% for CT, 97.0% for NG, and 92.3% for MG. Pooling failed to detect 8 infections, but pooled-sample analysis missed detecting only samples with a low bacterial load (cycle threshold >35). Conclusions Pooling samples from MSM to detect CT, NG, and MG is as sensitive as individual-site testing for these 3 pathogens using the Allplex assay. Missed infections with a very low bacterial load could have a low impact on further transmission. Clinical Trials Registration. NCT03568695.
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Affiliation(s)
- Thierry Prazuck
- Service des maladies infectieuses et tropicales, CHR Orléans, Orleans, France
| | - Philippe Lanotte
- Service de bacteriologie-virologie, Centre Hospitalier Universitaire Tours, Tours, France
| | - Gwénaël Le Moal
- Service des maladies infectieuses, Centre Hospitalier Universitaire Poitiers, Poitiers, France
| | - Laurent Hocqueloux
- Service des maladies infectieuses et tropicales, CHR Orléans, Orleans, France
| | - Simon Sunder
- Service des maladies infectieuses, CH Niort, Niort, France
| | - Mélanie Catroux
- Service des maladies infectieuses, Centre Hospitalier Universitaire Poitiers, Poitiers, France
| | - Magali Garcia
- Laboratoire inflammation tissus épitheliaux et cytokines EA 4331, Université de Poitiers, Poitiers, France
| | | | - Guillaume Gras
- Service des maladies infectieuses, Centre Hospitalier Universitaire Tours, Tours, France
| | - Chloé Plouzeau
- Laboratoire de bactériologie, Centre Hospitalier Universitaire Poitiers, Poitiers, France
| | - Nicolas Lévêque
- Laboratoire inflammation tissus épitheliaux et cytokines EA 4331, Université de Poitiers, Poitiers, France
| | - Agnès Beby-Defaux
- Laboratoire de virologie et mycobactériologie, Centre Hospitalier Universitaire Poitiers, Poitiers, France
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Soliman S, Dogbey P, Pan S. Lymphogranuloma Venereum Mimicking Locally Metastatic Rectal Cancer in an HIV-Negative Man. Cureus 2021; 13:e20216. [PMID: 35004036 PMCID: PMC8729315 DOI: 10.7759/cureus.20216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 11/05/2022] Open
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Atefi D, McNulty A, Varma R. A curious case of cancer or chlamydia? Intern Med J 2021; 51:1975-1976. [PMID: 34796625 DOI: 10.1111/imj.15574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 11/29/2022]
Affiliation(s)
- David Atefi
- Sydney Sexual Health Centre, Sydney, New South Wales, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney, New South Wales, Australia.,School of Public Health, UNSW, Sydney, New South Wales, Australia
| | - Rick Varma
- Sydney Sexual Health Centre, Sydney, New South Wales, Australia.,The Kirby Institute, UNSW, Sydney, New South Wales, Australia
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de Vries HJC, Nori AV, Kiellberg Larsen H, Kreuter A, Padovese V, Pallawela S, Vall-Mayans M, Ross J. 2021 European Guideline on the management of proctitis, proctocolitis and enteritis caused by sexually transmissible pathogens. J Eur Acad Dermatol Venereol 2021; 35:1434-1443. [PMID: 34057249 DOI: 10.1111/jdv.17269] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/24/2021] [Indexed: 12/14/2022]
Abstract
This guideline intents to offer guidance on the diagnosis and management of patients with gastrointestinal symptoms and a suspected sexually transmitted cause. Proctitis is defined as an inflammatory syndrome of the anal canal and/or the rectum. Infectious proctitis can be sexually transmitted via genital-anal mucosal contact, but some also via digital contact and toys. Neisseria gonorrhoeae, Chlamydia trachomatis (including lymphogranuloma venereum), Treponema pallidum and herpes simplex virus are the most common sexually transmitted anorectal pathogens. Shigellosis can be transferred via oral-anal contact and may lead to proctocolitis or enteritis. Although most studies on these infections have concentrated on men who have sex with men (MSM), women having anal intercourse may also be at risk. A presumptive clinical diagnosis of proctitis can be made when there are symptoms and signs, and a definitive diagnosis when the results of laboratory tests are available. The symptoms of proctitis include anorectal itching, pain, tenesmus, bleeding, constipation and discharge in and around the anal canal. The majority of rectal chlamydia and gonococcal infections are asymptomatic and can only be detected by laboratory tests. Therefore, especially when there is a history of receptive anal contact, exclusion of anorectal infections is generally indicated as part of standard screening for sexually transmitted infections (STIs). Condom use does not guarantee protection from STIs, which are often spread without penile penetration. New in this updated guideline is: (i) lymphogranuloma venereum proctitis is increasingly found in HIV-negative MSM, (ii) anorectal Mycoplasma genitalium infection should be considered in patients with symptomatic proctitis after exclusion of other common causations such N. gonorrhoeae, C. trachomatis, syphilis and herpes, (iii) intestinal spirochetosis incidentally found in colonic biopsies should not be confused with syphilis, and (iv) traumatic causes of proctitis should be considered in sexually active patients.
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Affiliation(s)
- H J C de Vries
- STI Outpatient Clinic, Cluster Infectious Diseases, Health Service Amsterdam, Amsterdam, The Netherlands
- Department of Dermatology, Amsterdam Institute for Infection and Immunity (AII), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A V Nori
- Department of Sexual & Reproductive Health and HIV Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - H Kiellberg Larsen
- Department of Dermatology and Venereology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark
| | - A Kreuter
- Department of Dermatology, Venereology, and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University Witten-Herdecke, Oberhausen, Germany
| | - V Padovese
- Genitourinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta
| | - S Pallawela
- The Florey Unit, Royal Berkshire Hospital, Reading, UK
| | - M Vall-Mayans
- Infectious Diseases Department, Fight AIDS Foundation, Hospital Germans Trias Pujol, Badalona, Spain
| | - J Ross
- Department of Sexual Health and HIV, Birmingham University Hospitals NHS Foundation Trust, Birmingham, UK
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10
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Evaluation of 2 Commercial Assays for the Detection of Lymphogranuloma Venereum in Rectal Samples. Sex Transm Dis 2021; 47:162-164. [PMID: 31876865 DOI: 10.1097/olq.0000000000001120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The early identification of the Chlamydia trachomatis variants that cause lymphogranuloma venereum (LGV) is very important to establish an adequate antibiotic treatment. This identification should be made with molecular techniques that are easy to perform and accessible to most microbiology laboratories. The objective of this study was to evaluate 2 real-time polymerase chain reaction (PCR)-based assay (VIASURE Haemophilus ducreyi + C. trachomatis (LGV) real-time PCR detection kit and the Allplex Genital ulcer Assay) for the detection of LGV in rectal samples. MATERIALS AND METHODS Prospective study on positive rectal samples for C. trachomatis. All samples were processed in parallel by both tests. As a molecular reference method and to solve possible discrepancies between both assays, a PCR-based restriction fragment length polymorphism analysis of the major outer membrane protein gene (omp1) was used. RESULTS In total, we detected 157 positive rectal samples for C. trachomatis, of which 36 were identified as LGV by PCR-based restriction fragment length polymorphism analysis. The positive percent agreement, negative percent agreement, and overall percent agreement were 88.9%, 100%, and 97.3%, respectively, for the Allplex Genital ulcer assay and 91.6%, 100%, and 97.1%, respectively, for the VIASURE assay. In the direct comparison between the Seegene assay and the VIASURE assay, we obtained a kappa concordance index of 0.98 between both tests. CONCLUSIONS According to the results obtained, both tests could be used for the detection of LGV in rectal samples.
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Waters KM, Cox BK, Wong MT, Guindi M, Kim SA, Larson BK, Morgan M, Voltaggio L, Balzer BL. Lymphogranuloma venereum (LGV) of the anorectum: evaluation of clinicopathological associations and the utility of a novel RNA in-situ hybridisation stain. Histopathology 2020; 78:392-400. [PMID: 32780441 DOI: 10.1111/his.14232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 11/30/2022]
Abstract
AIMS Recent studies from multiple global regions have reported a resurgence of lymphogranuloma venereum (LGV) proctitis, which is caused by Chlamydia trachomatis (CT). LGV proctitis is histologically indistinguishable from other forms of sexually transmitted proctitis and is difficult to differentiate from inflammatory bowel disease. While immunohistochemical stains are available for syphilis, there is no commonly available stain for the tissue identification of CT. MATERIALS AND METHODS From 200 positive CT nucleic acid tests (NAT) from anorectal swabs, we identified 12 patients with biopsies collected from the distal colorectum or anus within 90 days of the positive NAT. We collected basic demographic information and tabulated clinical and histological findings. We examined the performance of a novel RNA in-situ hybridisation (ISH) stain targeting CT 23s rRNA on these 12 cases and 10 controls from the anorectum. RESULTS All 12 patients were male; nine were HIV+, two had concurrent gonococcal infection, one had concurrent syphilis and one had cytomegalovirus co-infection. The majority of biopsies (11 of 12) showed mild or moderate acute inflammation, had a prominent lymphoplasmacytic infiltrate (eight of 11) and lacked marked crypt distortion (10 of 10). The RNA ISH stain was positive in 10 of 12 cases (sensitivity 83%). One case showed equivocal staining. No controls showed definitive positive staining (specificity 100%). One had equivocal staining. CONCLUSION Our series showed that anorectal LGV had similar histological findings to those of prior STI proctitis series predominantly comprised of syphilis. The novel RNA ISH stain was sensitive and specific and may show utility in differentiating types of STI proctitis.
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Affiliation(s)
- Kevin M Waters
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Brian K Cox
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mary T Wong
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Maha Guindi
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Stacey A Kim
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Brent K Larson
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Margie Morgan
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Bonnie L Balzer
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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12
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Abstract
Sexually transmitted infections (STIs) are diseases that are transmitted from one person to another person through acts of vaginal, anal, or oral intercourse. The increased presence of STIs among men who have sex with men (MSM) results in a higher rate of STI-related diagnoses, such as proctitis. Proctitis is a common, but often misdiagnosed condition experienced by MSM who present to primary care, urgent care, and emergency settings. It is important that health care providers be knowledgeable of the pathophysiology, risk factors, and clinical presentation of proctitis among MSM for accurate and timely management.
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Affiliation(s)
- Julia M Steed
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA.
| | - Queen Henry-Okafor
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA
| | - Courtney J Pitts
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA
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Smit PW, Cornelissen AR, Bruisten SM. Reduction of non-typeable results using a plasmid oriented Lymfogranuloma venereum PCR for typing of Chlamydia trachomatis positive samples. PLoS One 2020; 15:e0233990. [PMID: 32497069 PMCID: PMC7271987 DOI: 10.1371/journal.pone.0233990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 05/16/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives Typing of Chlamydia trachomatis (CT) is traditionally performed by characterising the ompA gene, resulting in more than a dozen different genovars, A to L. Type L is associated with Lymphogranuloma venereum (LGV) and commonly screened for using PCR, targeting the chromosomal pmpH gene. We aimed to develop and validate a new CT/LGV plasmid-based typing assay targeting the pgp3 gene, to increase sensitivity and thus reduce the number of non-typeable results. Methods The new pgp3 PCR assay using LNA probes to detect point mutations was analytically and prospectively validated in a routine diagnostic laboratory setting. For the analytical tests, quantified nucleotide constructs (gBlocks) were used to perform limit of detection analyses. Quality control panel samples from 2018 and 2019 for CT were also tested. For the clinical study patient samples which were collected in two months in 2018 were tested simultaneously using the pmpH PCR and the pgp3 PCR. Results Analytically, the assay proved to be 100% specific relative to the previously used LGV typing assay targeting the single copy pmpH gene but it was much more sensitive to detect non-LGV CT. In the quality control panel 2 nonLGV samples and 7 LGV samples were solely positive with the pgp3 PCR and not with the pmpH PCR. None of the samples from analytical specificity panels were positive, indicating 100% specificity. In a prospective panel of 152 clinical samples, 142 (93%) were successfully typed with the pgp3 PCR compared to 78% with the pmpH PCR. The pgp3 PCR was fully concordant with the pmpH PCR to identify all LGV subtypes and detected an increased number of clinical samples of non-LGV subtype. Conclusion We developed and validated a sensitive and specific plasmid-based typing assay to discriminate LGV from non-LGV CT subtypes. This is useful in a clinical setting to quickly determine the optimal treatment for Chlamydia trachomatis infections.
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Affiliation(s)
- Pieter Willem Smit
- Public Health Laboratory (GGD) Amsterdam, Department of infectious diseases, Amsterdam, The Netherlands
- Medical Microbiology Laboratory, Maasstad ziekenhuis, Rotterdam, The Netherlands
| | - Akke Rosanne Cornelissen
- Public Health Laboratory (GGD) Amsterdam, Department of infectious diseases, Amsterdam, The Netherlands
| | - Sylvia Maria Bruisten
- Public Health Laboratory (GGD) Amsterdam, Department of infectious diseases, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Amsterdam Infection & Immunity Institute (AI&II), Amsterdam, The Netherlands
- * E-mail:
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14
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Neri B, Stingone C, Romeo S, Sena G, Gesuale C, Compagno M, De Cristofaro E, Baciorri F, Del Vecchio Blanco G, Palmieri G, Sarmati L, Biancone L. Inflammatory bowel disease versus Chlamydia trachomatis infection: a case report and revision of the literature. Eur J Gastroenterol Hepatol 2020; 32:454-457. [PMID: 31851086 DOI: 10.1097/meg.0000000000001605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Infectious proctitis may mimic inflammatory bowel disease, particularly when limited to the rectum. The present case report includes findings from a 50-year-old man, soldier, referring to our Inflammatory Bowel Disease Unit with a diagnosis of rectal Crohn's disease, refractory to conventional treatments. Mild anemia, hypergammaglobulinemia and HIV-antibodies seronegativity were detected. Entero-MRI and stool examinations were negative. Ileocolonoscopy detected few rectal ulcers with irregular edges. Endosonography showed marked thickening of the rectal wall and enlarged perirectal lymphnodes. Nodal and rectal fine needle aspirate did not show atypia (PAN CK-). Rectal biopsies showed flogistic granular tissue (PAN CK-): Warthin-Starry stain was negative. Previous Treponema pallidum infection was detected. Clinical history revealed habits at risk for sexually transmitted infection. Rectal swabs for RT-PCR for Chlamydia trachomatis, Neisseria gonorrhoeae, and Herpes Simplex Virus 1-2 lead to a diagnosis of lymphogranuloma venereum. Doxycycline 100 mg and Azitromicyn 500 mg t.i.d. were given for 21 days, followed by negativity for RT-PCR for Chlamydia trachomatis at rectal swabs. Complete disappearance of symptoms and mucosal healing occurred. Due to the increased frequency of infectious diseases, sexually transmitted infection (including lymphogranuloma venereum) should be considered as possible differential diagnosis when assessing patients with inflammatory bowel disease limited to the rectum.
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Affiliation(s)
- Benedetto Neri
- Department of Systems Medicine, Unit of Gastroenterology, University 'Tor Vergata' of Rome
| | - Christof Stingone
- Department of Systems Medicine, Unit of Infectious Diseases, University 'Tor Vergata' of Rome, Rome
| | - Samanta Romeo
- Department of Systems Medicine, Unit of Gastroenterology, University 'Tor Vergata' of Rome
- AAST Ospedale Maggiore di Crema, Scienze mediche, Unità di Gastroenterologia ed Endoscopia Digestiva, Crema
| | - Giorgia Sena
- Department of Systems Medicine, Unit of Gastroenterology, University 'Tor Vergata' of Rome
| | - Cristina Gesuale
- Department of Systems Medicine, Unit of Gastroenterology, University 'Tor Vergata' of Rome
| | - Mirko Compagno
- Department of Systems Medicine, Unit of Infectious Diseases, University 'Tor Vergata' of Rome, Rome
| | - Elena De Cristofaro
- Department of Systems Medicine, Unit of Gastroenterology, University 'Tor Vergata' of Rome
| | | | | | | | - Loredana Sarmati
- Department of Systems Medicine, Unit of Infectious Diseases, University 'Tor Vergata' of Rome, Rome
| | - Livia Biancone
- Department of Systems Medicine, Unit of Gastroenterology, University 'Tor Vergata' of Rome
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Mwasakifwa GE, Nugent C, Varma R. Proctitis in gay and bisexual men. Are microscopy and proctoscopy worthwhile? Sex Transm Infect 2020; 96:475-477. [PMID: 32001659 DOI: 10.1136/sextrans-2019-054197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/15/2019] [Accepted: 01/12/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We explored the association between nucleic acid amplification testing (NAAT) and rectal microscopy/proctoscopy findings and correlates of rectal STIs among 150 gay and bisexual men (GBM) diagnosed with proctitis at the Sydney Sexual Health Centre from March 2016 to October 2017. METHODS From case files, we analysed risk behaviours, microscopy, proctoscopy and NAAT results for rectal STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, herpes simplex virus type 1/2, lymphogranuloma venereum and syphilis). χ2 test assessed the association between microscopy/proctoscopy findings and NAAT results. Linear regression assessed the association between NAAT positivity and correlates of rectal STIs. RESULTS The mean age was 32.5 (9.8) years, 43% (65/150) were taking pre-exposure prophylaxis, 17% (26/150) were HIV positive and 24% (36/147) had multiple rectal STIs.Among GBM with documented proctoscopy findings (n=113), 58% (65/113) had discharge, 36% (41/113) had anorectal erythema and 25% (28/113) had bleeding. A quarter of GBM (28/113) had negative proctoscopy findings.Discharge found on proctoscopy (p=0.001), positive HIV status (p=0.030) and time since last receptive anal intercourse (p=0.028) were independently associated with NAAT positivity for any rectal STI. Discharge had a positive likelihood ratio of 1.6 (95% CI 1.0 to 2.4).Among those with documented microscopy findings (n=69), 59% (41/69) and 41% (28/69) were NAAT positive and negative, respectively. Among NAAT-positive GBM, 27 (66%) had polymorphonuclear cells (PMNs) (mean number of PMNs, 10 (SD 9) cells per oil immersion field), 1 (2%) had Gram-negative intracellular diplococci and 11 (27%) had negative findings. There was no significant association between microscopy findings and NAAT results (p=0.651) or the number of rectal STI (p=0.279). CONCLUSION Microscopy does not reliably provide information necessary to tailor the management of GBM diagnosed with proctitis. Discharge found during proctoscopy may identify GBM with rectal STI. Services should consider recommendations to perform these investigations.
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Affiliation(s)
- Gwamaka Eliudi Mwasakifwa
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia .,Sydney Sexual Health Centre, Sydney, NSW, Australia
| | | | - Rick Varma
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,Sydney Sexual Health Centre, Sydney, NSW, Australia
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16
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Lymphoganuloma venereum in the Western world, 15 years after its re-emergence: new perspectives and research priorities. Curr Opin Infect Dis 2020; 32:43-50. [PMID: 30507675 DOI: 10.1097/qco.0000000000000519] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW Lymphogranuloma venereum (LGV) is a serious sexually transmitted infection caused by Chlamydia trachomatis. If left untreated LGV can cause irreversible late sequelae. LGV is endemic among a high-risk population of men who have sex with men (MSM), and largely reported in Western metropoles. RECENT FINDINGS Although the majority of LGV patients are HIV positive, in recent years the proportion of HIV-negative MSM with LGV is rising. This could indicate a shift toward lower risk populations. Apart from a few European countries, no proper LGV surveillance efforts have been implemented so far. Moreover, a considerable proportion of the infections are asymptomatic. As a result, the true magnitude of the LGV epidemic is underestimated.Depending on the stage and location of infection, LGV manifests in a variety of clinical presentations. Among MSM, anorectal infections are overreported as opposed to genital LGV infections in a ratio of 15 to 1, respectively. Therefore, other modes of transmission apart from anal sex are here discussed. SUMMARY To improve surveillance, cheaper and more practical screening methods are needed. Moreover, randomized clinical trials are needed to evaluate more simple treatment modalities as opposed to the currently recommended 3-week course of doxycycline.
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17
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López LS, La Rosa L, Entrocassi AC, Caffarena D, Santos B, Fermepin MR. Rectal Lymphogranuloma Venereum, Buenos Aires, Argentina. Emerg Infect Dis 2019; 25:598-599. [PMID: 30789332 PMCID: PMC6390746 DOI: 10.3201/eid2503.180600] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Among 34 men with proctitis in Buenos Aires, Argentina, 16 (47%) had Chlamydia trachomatis infection, 11 (68.8%) of which were biovar lymphogranuloma venereum. The outbreak was probably local, as in Europe. In Argentina, lymphogranuloma venereum should be a suspected cause of proctitis in HIV-infected men who have had unprotected anal sex with men.
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18
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Maliyar K, Mufti A, Syed M, Selk A, Dutil M, Bunce PE, Alavi A. Genital Ulcer Disease: A Review of Pathogenesis and Clinical Features. J Cutan Med Surg 2019; 23:624-634. [PMID: 31253050 DOI: 10.1177/1203475419858955] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Genital ulcer disease can be caused by a wide variety of sources. Most commonly, genital ulcer disease is grouped into infectious and noninfectious causes. HSV, syphilis, lymphogranuloma venereum, and chancroid represent some common infectious ulcers. Noninfectious causes on the other hand can be inflammatory, noninflammatory, or malignant (eg, squamous cell carcinoma). Depending on the etiology, genital ulcers may present with unique features that can help clinicians identify the etiology and start treatment in a timely manner. The clinical presentation and management of infectious and noninfectious genital ulcers will be discussed in this review.
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Affiliation(s)
| | | | - Maleeha Syed
- Faculty of Medicine, University of Ottawa, ON, Canada
| | - Amanda Selk
- Department of Obstetrics and Gynecology, Women's College Hospital, University of Toronto, ON, Canada
| | - Maha Dutil
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | - Paul E Bunce
- Division of Infectious Diseases, Department of Medicine, University of Toronto, ON, Canada
| | - Afsaneh Alavi
- Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, ON, Canada
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19
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de Vries HJC, de Barbeyrac B, de Vrieze NHN, Viset JD, White JA, Vall-Mayans M, Unemo M. 2019 European guideline on the management of lymphogranuloma venereum. J Eur Acad Dermatol Venereol 2019; 33:1821-1828. [PMID: 31243838 DOI: 10.1111/jdv.15729] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/17/2019] [Indexed: 11/26/2022]
Abstract
New or important issues in this updated version of the 2013 European guideline on the management of lymphogranuloma venereum (LGV): EPIDEMIOLOGY: Lymphogranuloma venereum continues to be endemic among European men who have sex with men (MSM) since 2003. Lymphogranuloma venereum infections in heterosexuals are extremely rare in Europe, and there is no evidence of transmission of LGV in the European heterosexual population. AETIOLOGY AND TRANSMISSION Chlamydia trachomatis serovars/genovars L2b and L2 are the causative strains in the majority of cases in Europe. CLINICAL FEATURES Among MSM, about 25% of the anorectal LGV infections are asymptomatic. Genital infections among MSM are rare; the ratio of genital vs. anorectal LGV infections is 1 in 15. DIAGNOSIS To diagnose LGV, a sample tested C. trachomatis positive with a commercial nucleic acid amplification test (NAAT) platform should be confirmed with an LGV discriminatory NAAT. TREATMENT Doxycycline 100 mg twice a day orally for 21 days is the recommended treatment for LGV. This same treatment is recommended also in asymptomatic patients and contacts of LGV patients. If another regimen is used, a test of cure (TOC) must be performed.
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Affiliation(s)
- H J C de Vries
- STI Outpatient Clinic, Infectious Diseases Department, Public Health Service Amsterdam, Amsterdam, The Netherlands.,Department of Dermatology, Amsterdam Institute for Infection and Immunity (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - B de Barbeyrac
- Mycoplasmal and Chlamydial Infections in Humans, University of Bordeaux, Bordeaux, France.,Mycoplasmal and Chlamydial Infections in Humans, INRA, Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Laboratoire de Bacteriologie, French National Reference Center for Bacterial STIs, Bordeaux, France
| | - N H N de Vrieze
- Department of Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J D Viset
- Department of Dermatology, Amsterdam Institute for Infection and Immunity (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J A White
- Department of Genitourinary Medicine, Western Health & Social Care Trust, Londonderry, UK
| | - M Vall-Mayans
- STI Unit Vall d'Hebron-Drassanes, Department of Infectious Diseases, Hospital Vall d'Hebron, Barcelona, Spain
| | - M Unemo
- WHO Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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20
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Abstract
Sexually transmitted diseases (STDs) continue to be underrecognized leading to devastating health and economic consequences. Emergency clinicians play an important role in diagnosing and managing STDs and in improving health care outcomes for both the patient and their partners. In addition, antibiotic resistance and emerging infections continue to challenge providers in clinical practice. This review focuses on the cause, history, physical examination, diagnostic studies, and treatment strategies for bacterial vaginosis, chlamydia, genital herpes, gonorrhea, human papillomavirus, granuloma inguinale, Lymphogranuloma Venereum, Mycoplasma genitalium, syphilis, and trichomoniasis.
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Affiliation(s)
- Camiron L Pfennig
- Prisma Health, University of South Carolina School of Medicine Greenville, 701 Grove Road, Greenville, SC 29605, USA.
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21
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Foschi C, Gaspari V, Sgubbi P, Salvo M, D'Antuono A, Marangoni A. Sexually transmitted rectal infections in a cohort of 'men having sex with men'. J Med Microbiol 2018; 67:1050-1057. [PMID: 29927376 DOI: 10.1099/jmm.0.000781] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE We assessed the prevalence and predictors of Chlamydia trachomatis, Neisseriagonorrhoeae and Mycoplasmagenitalium rectal infections in a population of 'men having sex with men' (MSM). METHODOLOGY From January to November 2017, 165 MSM attending a STI outpatients clinic in Bologna (Italy) and reporting unsafe anal intercourses were enrolled. An ano-rectal swab was collected from each patient: chlamydial and gonococcal infections were diagnosed by a commercial NAAT, whereas an in-house quantitative PCR was used for M. genitalium detection. In addition, 131 urine samples and 84 pharyngeal swabs underwent testing for C. trachomatis and N. gonorrhoeae. A molecular C. trachomatis typing, a serological screening for anti-Chlamydia IgG and IgA, as well as the assessment of HIV, HCV and syphilis infections, were performed.Results/Key findings. The prevalence of C. trachomatis, N. gonorrhoeae and M. genitalium rectal infections was 27.2, 25.4 and 4.8 %, respectively. Globally, 63.1 % of cases were asymptomatic and up to 80 % of chlamydial and gonococcal infections would have been missed if the rectal site had not been tested. All the patients with rectal M. genitalium carriage were asymptomatic and characterized by low bacterial loads (<2500 DNA copies/reaction). Lymphogranuloma venereum (LGV) prevalence was 12.1 % with a considerable proportion of asymptomatic infections (35 %). The presence of symptoms, age >30, HIV-positivity and elevated levels of anti-Chlamydia antibodies were the most significant predictors of LGV. CONCLUSIONS Sexually transmitted rectal infections are frequent and often asymptomatic among MSM. LGV prevalence is high in our country and there is increasing evidence of symptomless cases.
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Affiliation(s)
- Claudio Foschi
- 1Microbiology, DIMES, University of Bologna, Bologna, Italy
| | | | - Paola Sgubbi
- 2Dermatology, DIMES, University of Bologna, Bologna, Italy
| | - Melissa Salvo
- 1Microbiology, DIMES, University of Bologna, Bologna, Italy
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22
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Low Prevalence of Urethral Lymphogranuloma Venereum Infections Among Men Who Have Sex With Men: A Prospective Observational Study, Sexually Transmitted Infection Clinic in Amsterdam, the Netherlands. Sex Transm Dis 2018; 44:547-550. [PMID: 28809772 PMCID: PMC5559185 DOI: 10.1097/olq.0000000000000657] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Among men who have sex with men, urethral lymphogranuloma venereum was diagnosed 15 times less often than anorectal LGV. Genital-anal contact seems not the only mode of transmission. Other modes like oral-anal transmission should be considered. In contrast to anorectal lymphogranuloma venereum (LGV), few urogenital LGV cases are reported in men who have sex with men. Lymphogranuloma venereum was diagnosed in 0.06% (7/12,174) urine samples, and 0.9% (109/12,174) anorectal samples. Genital-anal transmission seems unlikely the only mode of transmission. Other modes like oral-anal transmission should be considered.
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23
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Clinical diagnostic and therapeutic aspects of 221 consecutive anorectal Chlamydia trachomatis and Neisseria gonorrhoeae sexually transmitted infections among men who have sex with men. Int J Infect Dis 2018; 71:9-13. [PMID: 29608959 DOI: 10.1016/j.ijid.2018.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/22/2018] [Accepted: 03/25/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Proctitis caused by Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are known as sexually transmitted infections (STI). This study describes their clinical, diagnostic and therapeutic aspects. METHODS Between 01/2013-03/2015, all MSM consulting for proctitis at proctology Institute-Saint-Joseph's Hospital, Paris, were included. Demographic, past-medical history, STI status and medical treatment were collected. Detection of CT/NG was performed by Transcription-Mediated Amplification (TMA) and antimicrobial susceptibilities for Ng by agar diffusion method. RESULTS On 441 rectal samples collected, 221 (50.1%) were positive: 109 Ct (49.3%), 70 Ng (31.7%), 42 positive for both etiologies (19%). Among Ng infections, no resistance was detected to azithromycin and ceftriaxone. However, 84 strains (43.2%) were resistant to fluoroquinolones. More than one episode was diagnosed for 10 (5.1%) and 12 (6.2%) patients with CT and NG infections respectively. Anal abscesses were found for 27 (13.9%) patients, and 14 (7.2%) of them underwent surgery for anal fistula. CONCLUSIONS The prevalence of CT/NG anorectal infections described is high on symptomatic patients, and a significant level of abscess was reported. These results confirm the interest of the association of recommended antibiotics excluding quinolones. Prospective studies would be relevant on complicated forms of anorectal infections.
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The Enigma of Lymphogranuloma Venereum Spread in Men Who Have Sex With Men: Does Ano-Oral Transmission Plays a Role? Sex Transm Dis 2018; 43:420-2. [PMID: 27322041 DOI: 10.1097/olq.0000000000000466] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Laboratory Processes for Confirmation of Lymphogranuloma Venereum Infection During a 2015 Investigation of a Cluster of Cases in the United States. Sex Transm Dis 2018; 44:691-694. [PMID: 28876314 DOI: 10.1097/olq.0000000000000667] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In September 2015, the Centers for Disease Control and Prevention were notified of a suspected outbreak investigation of lymphogranuloma venereum (LGV) cases by the Michigan Department of Health and Human Services. The Centers for Disease Control and Prevention offered support with a laboratory-developed polymerase chain reaction test for LGV. This note describes the laboratory workflow and procedures used for the laboratory confirmation of LGV infection.
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Caballero-Mateos AM, López de Hierro-Ruiz M, Rodríguez-Domínguez M, Galán-Montemayor JC, Gutiérrez-Fernández J. Co-infection by lymphogranuloma venereum and Haemophilus parainfluenzae during an episode of proctitis. GASTROENTEROLOGIA Y HEPATOLOGIA 2018; 41:107-109. [PMID: 28196678 DOI: 10.1016/j.gastrohep.2016.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 12/14/2016] [Accepted: 12/23/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Mario Rodríguez-Domínguez
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España; CIBER en Epidemiología y Salud Pública, España
| | - Juan Carlos Galán-Montemayor
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España; CIBER en Epidemiología y Salud Pública, España
| | - José Gutiérrez-Fernández
- Servicio de Microbiología, Complejo Hospitalario Universitario de Granada-ibsGranada, Granada, España; Departamento de Microbiología, Universidad de Granada-ibsGranada, Granada, España.
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Clutterbuck D, Asboe D, Barber T, Emerson C, Field N, Gibson S, Hughes G, Jones R, Murchie M, Nori AV, Rayment M, Sullivan A. 2016 United Kingdom national guideline on the sexual health care of men who have sex with men. Int J STD AIDS 2018:956462417746897. [PMID: 29334885 DOI: 10.1177/0956462417746897] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
This guideline is intended for use in UK Genitourinary medicine clinics and sexual health services but is likely to be of relevance in all sexual health settings, including general practice and Contraception and Sexual Health (CASH) services, where men who have sex with men (MSM) seek sexual health care or where addressing the sexual health needs of MSM may have public health benefits. For the purposes of this document, MSM includes all gay, bisexual and all other males who have sex with other males and both cis and trans men. This document does not provide guidance on the treatment of particular conditions where this is covered in other British Association for Sexual Health and HIV (BASHH) Guidelines but outlines best practice in multiple aspects of the sexual health care of MSM. Where prevention of sexually transmitted infections including HIV can be addressed as an integral part of clinical care, this is consistent with the concept of combination prevention and is included. The document is designed primarily to provide guidance on the direct clinical care of MSM but also makes reference to the design and delivery of services with the aim of supporting clinicians and commissioners in providing effective services. Methodology This document was produced in accordance with the guidance set out in the BASHH CEG's document 'Framework for guideline development and assessment' published in 2010 at http://www.bashh.org/guidelines and with reference to the Agree II instrument. Following the production of the updated framework in April 2015, the GRADE system for assessing evidence was adopted and the draft recommendations were regraded. Search strategy (see also Appendix 1) Ovid Medline 1946 to December 2014, Medline daily update, Embase 1974 to December 2014, Pubmed NeLH Guidelines Database, Cochrane library from 2000 to December 2014. Search language English only. The search for Section 3 was conducted on PubMed to December 2014. Priority was given to peer-reviewed papers published in scientific journals, although for many issues evidence includes conference abstracts listed on the Embase database. In addition, for 'Identification of problematic recreational drug and alcohol use' section and 'Sexual problems and dysfunctions in MSM' section, searches included PsycINFO. Methods Article titles and abstracts were reviewed and if relevant the full text article was obtained. Priority was given to randomised controlled trial and systematic review evidence, and recommendations made and graded on the basis of best available evidence. Piloting and feedback The first draft of the guideline was circulated to the writing group and to a small group of relevant experts, third sector partners and patient representatives who were invited to comment on the whole document and specifically on particular sections. The revised draft was reviewed by the CEG and then reviewed by the BASHH patient/public panel and posted on the BASHH website for public consultation. The final draft was piloted before publication. Guideline update The guidelines will be reviewed and revised in five years' time, 2022.
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Affiliation(s)
| | - David Asboe
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - Tristan Barber
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | | | - Nigel Field
- 4 Public Health England, London, UK
- 5 University College London, London, UK
| | | | | | - Rachael Jones
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | | | - Achyuta V Nori
- 8 8945 Guy's and St Thomas' NHS Foundation Trust , London, UK
| | - Michael Rayment
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - Ann Sullivan
- 9 BASHH CEG, BASHH 2017 Registered Office, Macclesfield, UK
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Anorectal Lymphogranuloma Venereum in Madrid: A Persistent Emerging Problem in Men Who Have Sex With Men. Sex Transm Dis 2017; 43:414-9. [PMID: 27322040 DOI: 10.1097/olq.0000000000000459] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Since 2003, outbreaks of lymphogranuloma venereum (LGV) with anorectal syndrome have been increasingly recognized in many Western countries. All of them have been classified as LGV serovar L2b, mainly occurring in human immunodeficiency virus (HIV)-infected men who have had sex with men (MSM). We describe a series of 26 diagnosed cases of LGV proctitis in downtown Madrid, Spain, in 2014, after implementing routine diagnostic procedures for this disease in symptomatic MSM. METHODS We conducted an observational study of patients with symptomatic proctitis attending an outpatient infectious diseases clinic in Madrid, Spain during calendar year 2014. Clinical, epidemiological, laboratory, and therapeutic data were gathered and analyzed. RESULTS Twenty-six patients were included in the analysis. All were MSM, and 24 of them were HIV-positive. All patients reported having acute proctitis symptoms including tenesmus (85%), pain (88%), constipation (62%), or anal discharge (96%). Proctoscopy showed mucopurulent exudate (25 patients [96%]), and rectal bleeding, with mucosal erythema and/or oedema in all cases. Rectal swabs were obtained from all patients, and LGV serovar L2 was confirmed in all of them. The cure rate was 100% after standard treatments with doxycycline 100 mg twice per day for 3 weeks. Simultaneous rectal infections with other sexually transmitted pathogens (gonorrhoea, herpes simplex virus, Mycoplasma genitalium) and systemic sexually transmitted diseases (STDs) (syphilis, acute HIV, and hepatitis C infections) were also documented in 12 patients (46%), but these co-infections did not appear to influence the clinical manifestations of LGV. CONCLUSIONS Anorectal LGV is a common cause of acute proctitis and proctocolitis among HIV-infected MSM who practice unprotected anal sex, and it is frequently associated with other rectal STDs. The implementation of routine screening and prompt diagnosis of these rectal infections should be mandatory in all clinical settings attended by HIV and STD patients.
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Speers DJ, Chua ILJ, Manuel J, Marshall L. Detection of Neisseria gonorrhoeae and Chlamydia trachomatis from pooled rectal, pharyngeal and urine specimens in men who have sex with men. Sex Transm Infect 2017; 94:293-297. [PMID: 29066627 DOI: 10.1136/sextrans-2017-053303] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/24/2017] [Accepted: 10/08/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Screening of men who have sex with men (MSM) for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) requires sampling from anorectal and pharyngeal sites in addition to urogenital sampling. Due to the cost of testing multiple anatomical sites individually testing of pooled specimens has potential merit. The Cepheid GeneXpert CT/NG assay (GeneXpert), which also has potential for point-of-care nucleic acid testing in the sexual health clinic, has not been assessed for pooled specimen testing. METHODS We prospectively compared GeneXpert testing of pooled pharyngeal and rectal swabs with urine samples to standard of care testing of individual specimens from 107 participants using the Roche cobas 4800 CT/NG assay (cobas) for CT and NG in high-risk MSM attending an inner city sexual health clinic. RESULTS We found testing of pooled pharyngeal, rectal and urine samples by the GeneXpert to have 100% agreement for NG and 94% overall agreement for CT when compared with individual specimen testing by cobas. For CT testing, 14 cases were detected for both tests, 4for cobas only, 2 for GeneXpert only and 89 participants were negative for both tests. CONCLUSIONS Pooled specimen CT and NG testing by the GeneXpert was accurate when compared with single specimen testing and has potential for screening MSM for CT and NG. The role of pooled specimen testing with the GeneXpert as a point-of-care nucleic acid test in MSM requires further investigation.
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Affiliation(s)
- David John Speers
- Department of Microbiology, PathWest Laboratory Medicine WA (LMWA), Queen Elizabeth II (QEII) Medical Centre, Nedlands, Western Australia, Australia.,School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
| | - I-Ly Joanna Chua
- Department of Microbiology, PathWest Laboratory Medicine WA (LMWA), Queen Elizabeth II (QEII) Medical Centre, Nedlands, Western Australia, Australia
| | - Justin Manuel
- M Clinic, WA AIDS Council, West Perth, Western Australia, Australia
| | - Lewis Marshall
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia.,M Clinic, WA AIDS Council, West Perth, Western Australia, Australia
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Fernández-López C, Morales-Angulo C. Otorhinolaryngology Manifestations Secondary to Oral Sex. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.otoeng.2016.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fernández-López C, Morales-Angulo C. Otorhinolaryngology manifestations secondary to oral sex. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016; 68:169-180. [PMID: 27793330 DOI: 10.1016/j.otorri.2016.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/13/2016] [Accepted: 04/17/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Over the last few years, oral and pharyngeal signs and symptoms due to oral sex have increased significantly. However, no review articles related to this subject have been found in the medical literature. The objective of our study was to identify otorhinolaryngological manifestations associated with orogenital/oroanal contact, both in adults and children, in the context of consensual sex or sexual abuse. METHODS We performed a review of the medical literature on otorhinolaryngological pathology associated with oral sex published in the last 20 years in the PubMed database. RESULTS Otorhinolaryngological manifestations secondary to oral sex practice in adults can be infectious, tumoral or secondary to trauma. The more common signs and symptoms found in the literature were human papillomavirus infection (above all, condyloma acuminata and papilloma/condyloma), oral or pharyngeal syphilis, gonococcal pharyngitis, herpes simplex virus infection and pharyngitis from Chlamydia trachomatis. The incidence of human papillomavirus -induced oropharyngeal carcinoma has dramatically increased. In children past the neonatal period, the presence of condyloma acuminatus, syphilis, gonorrhoea or palatal ecchymosis (the last one, unless justified by other causes) should make us suspect sexual abuse. CONCLUSIONS Sexual habits have changed in the last decades, resulting in the appearance of otorhinolaryngological pathology that was rarely seen previously. For this reason, it is important for primary care physicians to have knowledge about the subject to perform correct diagnosis and posterior treatment. Some sexual abuse cases in children may also be suspected based on the knowledge of the characteristic oropharyngeal manifestations secondary to them.
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Affiliation(s)
- Claudia Fernández-López
- Servicio de Otorrinolaringología, Facultad de Medicina, Universidad de Cantabria, HUMV Santander, IDIVAL, Cantabria, Santander, España
| | - Carmelo Morales-Angulo
- Servicio de Otorrinolaringología, Facultad de Medicina, Universidad de Cantabria, HUMV Santander, IDIVAL, Cantabria, Santander, España.
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Leeyaphan C, Ong JJ, Chow EPF, Kong FYS, Hocking JS, Bissessor M, Fairley CK, Chen M. Systematic Review and Meta-Analysis of Doxycycline Efficacy for Rectal Lymphogranuloma Venereum in Men Who Have Sex with Men. Emerg Infect Dis 2016; 22:1778-84. [PMID: 27513890 PMCID: PMC5038401 DOI: 10.3201/eid2210.160986] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A high microbial cure rate was shown with 100 mg doxycycline twice daily for 21 days. Rectal lymphogranuloma venereum (LGV) has reemerged as a sexually transmitted infection among men who have sex with men (MSM), particularly those who are HIV-positive. We undertook a systematic review and meta-analysis to determine the efficacy of doxycycline (100 mg 2×/d for 21 days) for rectal LGV in MSM. Nine studies were included: 4 prospective, 4 retrospective, and 1 combined retrospective and prospective. In total, 282 MSM with rectal LGV were included in the studies. All studies reported using nucleic acid amplification tests to assess microbial cure. Most patients (>80%) had symptomatic rectal infection. The fixed-effects pooled efficacy for doxycycline was 98.5% (95% CI 96.3%–100%, I2 = 0%; p = 0.993). Doxycycline at 100 mg twice daily for 21 days demonstrated a high microbial cure rate. These data support doxycycline at this dosage and duration as first-line therapy for rectal LGV in MSM.
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Wright WF. Infectious Diseases Perspective of Anorectal Abscess and Fistula-in-ano Disease. Am J Med Sci 2016; 351:427-34. [PMID: 27079352 DOI: 10.1016/j.amjms.2015.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/21/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Anorectal abscess and fistula-in-ano is a rare disease with an exemplary prognosis. Most patients are diagnosed with cryptoglandular disease but unusual infections raise difficult antimicrobial management challenges. METHODS All primary references identified in PubMed, EMBASE, the ISI Web of Knowledge database and the Cochrane Library, published between 1960 and 2015, using the keywords "anorectal abscess," "fistula-in-ano," "perianal abscess," or "perianal fistula" or all, were uploaded into a database. The databases were also interrogated using keywords specific for each infection type studied. RESULTS In all, 52 relevant primary medical publications were identified. There were also 4 relevant organizational standards guideline publications, 1 relevant review and 4 historical publications about the diagnosis and outcomes of anorectal abscess and fistula-in-ano with data derived primarily from prospective and retrospective trials as well as institutional case series to provide an evidence level opinion. The use of antimicrobial therapy in combination with surgical incision and drainage in the treatment of cryptoglandular disease has failed to improved healing times or reduce recurrences or both. Based on limited data, routine antimicrobial therapy may benefit patients with significant comorbid conditions, extensive cellulitis and systemic symptoms. For patients with unusual infecting pathogens (eg, Mycobacterium tuberculosis, Actinomyces species and Chlamydia species) outcomes are favorable with selected antimicrobial therapy agents of various durations. CONCLUSION Surgical incision and drainage is the main treatment for anorectal abscess and fistula-in-ano, but a select group of patients with unusual infections benefit from tailored prolonged antimicrobial therapy with the overall recurrence rate remaining low.
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Affiliation(s)
- William F Wright
- Division of Infectious Diseases, Department of Medicine, Memorial Medical Center, York, PA.
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Tumefacción en región inguinal en varón VIH positivo. Semergen 2016; 42:e99-e100. [DOI: 10.1016/j.semerg.2015.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 07/28/2015] [Accepted: 07/31/2015] [Indexed: 11/19/2022]
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Emancipating Chlamydia: Advances in the Genetic Manipulation of a Recalcitrant Intracellular Pathogen. Microbiol Mol Biol Rev 2016; 80:411-27. [PMID: 27030552 DOI: 10.1128/mmbr.00071-15] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Chlamydia species infect millions of individuals worldwide and are important etiological agents of sexually transmitted disease, infertility, and blinding trachoma. Historically, the genetic intractability of this intracellular pathogen has hindered the molecular dissection of virulence factors contributing to its pathogenesis. The obligate intracellular life cycle of Chlamydia and restrictions on the use of antibiotics as selectable markers have impeded the development of molecular tools to genetically manipulate these pathogens. However, recent developments in the field have resulted in significant gains in our ability to alter the genome of Chlamydia, which will expedite the elucidation of virulence mechanisms. In this review, we discuss the challenges affecting the development of molecular genetic tools for Chlamydia and the work that laid the foundation for recent advancements in the genetic analysis of this recalcitrant pathogen.
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The "3 in 1" Study: Pooling Self-Taken Pharyngeal, Urethral, and Rectal Samples into a Single Sample for Analysis for Detection of Neisseria gonorrhoeae and Chlamydia trachomatis in Men Who Have Sex with Men. J Clin Microbiol 2015; 54:650-6. [PMID: 26719439 DOI: 10.1128/jcm.02460-15] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 12/22/2015] [Indexed: 11/20/2022] Open
Abstract
Triple-site testing (using pharyngeal, rectal, and urethral/first-void urine samples) for Neisseria gonorrhoeae and Chlamydia trachomatis using nucleic acid amplification tests detects greater numbers of infections among men who have sex with men (MSM). However, triple-site testing represents a cost pressure for services. MSM over 18 years of age were eligible if they requested testing for sexually transmitted infections (STIs), reported recent sexual contact with either C. trachomatis or N. gonorrhoeae, or had symptoms of an STI. Each patient underwent standard-of-care (SOC) triple-site testing, and swabs were taken to form a pooled sample (PS) (pharyngeal, rectal, and urine specimens). The PS was created using two methods during different periods at one clinic, but we analyzed the data in combination because the sensitivity of the two methods did not differ significantly for C. trachomatis (P = 0.774) or N. gonorrhoeae (P = 0.163). The sensitivity of PS testing (92%) was slightly lower than that of SOC testing (96%) for detecting C. trachomatis (P = 0.167). For N. gonorrhoeae, the sensitivity of PS testing (90%) was significantly lower than that of SOC testing (99%) (P < 0.001). When pharynx-only infections were excluded, the sensitivity of PS testing to detect N. gonorrhoeae infections increased to 94%. Our findings show that pooling of self-taken samples could be an effective and cost-saving method, with high negative predictive values. (Interim results of this study were presented at the BASHH 2013 summer meeting.).
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Lanjouw E, Ouburg S, de Vries HJ, Stary A, Radcliffe K, Unemo M. Background review for the '2015 European guideline on the management of Chlamydia trachomatis infections'. Int J STD AIDS 2015:0956462415618838. [PMID: 26608578 DOI: 10.1177/0956462415618838] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
SummaryChlamydia trachomatis infections are major public health concerns globally. Of particular grave concern is that the majority of persons with anogenital Chlamydia trachomatis infections are asymptomatic and accordingly not aware of their infection, and this silent infection can subsequently result in severe reproductive tract complications and sequelae. The current review paper provides all background, evidence base and discussions for the 2015 European guideline on the management of Chlamydia trachomatis infections (Lanjouw E, et al. Int J STD AIDS 2015). Comprehensive information and recommendations are included regarding the diagnosis, treatment and prevention of anogenital, pharyngeal and conjunctival Chlamydia trachomatis infections in European countries. However, Chlamydia trachomatis also causes the eye infection trachoma, which is not a sexually transmitted infection. The 2015 European Chlamydia trachomatis guideline provides up-to-date guidance regarding broader indications for testing and treatment of Chlamydia trachomatis infections; clearer recommendation of using validated nucleic acid amplification tests only for diagnosis; advice on (repeated) Chlamydia trachomatis testing; recommendation of increased testing to reduce the incidence of pelvic inflammatory disease and prevent exposure to infection and recommendations to identify, verify and report Chlamydia trachomatis variants. Improvement of access to testing, test performance, diagnostics, antimicrobial treatment and follow-up of Chlamydia trachomatis patients are crucial to control its spread.
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Affiliation(s)
- E Lanjouw
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - S Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - H J de Vries
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands STI Outpatient Clinic, Infectious Disease Cluster, Health Service Amsterdam, Amsterdam, The Netherlands Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - A Stary
- Outpatients' Centre for Infectious Venereodermatological Diseases, Vienna, Austria
| | - K Radcliffe
- University Hospital Birmingham Foundation NHS Trust, Birmingham, UK
| | - M Unemo
- WHO Collaborating Center for Gonorrhoea and other Sexually Transmitted Infections, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Nwokolo NC, Dragovic B, Patel S, Tong CYW, Barker G, Radcliffe K. 2015 UK national guideline for the management of infection with Chlamydia trachomatis. Int J STD AIDS 2015; 27:251-67. [PMID: 26538553 DOI: 10.1177/0956462415615443] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 10/09/2015] [Indexed: 01/26/2023]
Abstract
This guideline offers recommendations on the diagnostic tests, treatment regimens and health promotion principles needed for the effective management of Chlamydia trachomatis genital infection. It covers the management of the initial presentation, as well the prevention of transmission and future infection. The guideline is aimed at individuals aged 16 years and older presenting to healthcare professionals working in departments offering Level 3 care in sexually transmitted infections management within the UK. However, the principles of the recommendations should be adopted across all levels, using local care pathways where appropriate.
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Affiliation(s)
| | | | - Sheel Patel
- Chelsea and Westminster Hospital, London, UK
| | | | | | - Keith Radcliffe
- British Association for Sexual Health and HIV Clinical Effectiveness Group, London, UK
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Arnold CA, Roth R, Arsenescu R, Harzman A, Lam-Himlin DM, Limketkai BN, Montgomery EA, Voltaggio L. Sexually transmitted infectious colitis vs inflammatory bowel disease: distinguishing features from a case-controlled study. Am J Clin Pathol 2015; 144:771-81. [PMID: 26486742 DOI: 10.1309/ajcpoid4jij6pisc] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Sexually transmitted infectious (STI) colitis often raises concern for inflammatory bowel disease (IBD). In this study, we compare histologic features of IBD with STI colitis caused by syphilis and lymphogranuloma venereum. METHODS The STI colitis group included 10 unique colorectal biopsy specimens in patients with clinically confirmed syphilis and/or lymphogranuloma venereum. The STI biopsy specimens were compared with patients matched for age, sex, and site with Crohn disease (n = 10) or ulcerative colitis (n = 10). All IBD controls had an established history of IBD (up to 276 months of follow-up, mean follow-up = 102 months). RESULTS Discriminating features (P < .05) of STI colitis included its exclusive identification in human immunodeficiency virus-positive men who have sex with men, anal pain, and anal discharge. STI colitis contained the triad of (1) minimal active chronic crypt centric damage, (2) a lack of mucosal eosinophilia, and (3) submucosal plasma cells, endothelial swelling, and perivascular plasma cells. Nondiscriminating features (P > .05) included rectal bleeding, endoscopic appearance, skip lesions, ulcerations, aphthoid lesions, granulomata, foreign body giant cells, neural hyperplasia, fibrosis, and lymphoid aggregates. CONCLUSIONS While STI colitis shares many overlapping features with IBD, histologic and clinical discriminating features may be helpful when confronted with that differential diagnosis.
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Bánvölgyi A, Balla E, Bognár P, Tóth B, Ostorházi E, Bánhegyi D, Kárpáti S, Marschalkó M. [Lymphogranuloma venereum: the first Hungarian cases]. Orv Hetil 2015; 156:36-40. [PMID: 25544054 DOI: 10.1556/oh.2015.30083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Lymphogranuloma venereum is a sexually transmitted infection caused by the Chlamydia trachomatis serovars L1-3. It has been found to be endemic in tropical countries. In the last decades several cases have been reported in Western Europe, particularly in men who have sex with men population infected with human immunodeficiency virus. The authors present three cases of lymphogranuloma venereum infections, observed at their department in 2013 and 2014. The three human immunodeficiency virus infected patients who belonged to men who have sex with men population had casual sexual contacts in Western Europe. The symptoms included urethral discharge, discomfort and inguinal lymphadenomegaly in two patients, and rectal pain, discharge and perianal ulceration in one patient. The diagnosis was confirmed by nucleic acid amplification test performed in samples obtained from urethral discharge and exudate of perianal ulcer; lymphogranuloma venereum 2b serovars were demonstrated in two patients and serovar 2 in one patient. Doxycyclin (daily dose of two times 100 mg for 21 days) resolved the symptoms in all cases. The authors conclude that lymphogranuloma venereum is a diagnostic challenge in Hungary, too. It is important to be aware of the altered clinical features of this disease to prevent complications and spreading.
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Affiliation(s)
- András Bánvölgyi
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
| | - Eszter Balla
- Országos Epidemiológiai Központ II. Bakteriológiai Osztály, STI Laboratórium Budapest
| | - Péter Bognár
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
| | - Béla Tóth
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
| | - Eszter Ostorházi
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
| | - Dénes Bánhegyi
- Egyesített Szent László és Szent István Kórház V. Infektológiai Osztály Budapest
| | - Sarolta Kárpáti
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
| | - Márta Marschalkó
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
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Abstract
Lymphogranuloma venereum is a sexually transmitted disease caused by L1, L2, and L3 serovars of Chlamydia trachomatis. In the last 10 years outbreaks have appeared in North America, Europe, and Australia in the form of proctitis among men who have sex with men. Three stages of disease have been described. The disease in primary stage may go undetected when only a painless papule, pustule, or ulceration appears. The diagnosis is difficult to establish on clinical grounds alone and frequently relies upon either serologic testing, culture, or more recently, nucleic acid amplification testing of direct specimens. A proper treatment regimen cures the infection and prevents further damage to tissues. Lymphogranuloma venereum causes potentially severe infections with possibly irreversible sequels if adequate treatment is not begun promptly. Early and accurate diagnosis is essential. Doxycycline is the drug of choice. Pregnant and lactating women should be treated with erythromycin or azithromycin. Patient must be followed up during the treatment, until disease signs and symptoms have resolved. Repeated testing for syphilis, hepatitis B and C, and HIV to detect early infection should be performed.
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Affiliation(s)
- Romana Ceovic
- Department of Dermatology and Venereology, University Hospital Center Zagreb and School of Medicine, Zagreb, Croatia
| | - Sandra Jerkovic Gulin
- Department of Dermatology and Venereology, General Hospital Sibenik, Sibenik, Croatia
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Ali MA, Arnold CA, Singhi AD, Voltaggio L. Clues to uncommon and easily overlooked infectious diagnoses affecting the GI tract and distinction from their clinicopathologic mimics. Gastrointest Endosc 2014; 80:689-706. [PMID: 25070906 DOI: 10.1016/j.gie.2014.04.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 04/29/2014] [Indexed: 02/07/2023]
Affiliation(s)
- M Aamir Ali
- Department of Gastroenterology, George Washington University Hospital, Washington, District of Columbia, USA
| | | | - Aatur D Singhi
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lysandra Voltaggio
- Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Rönn M, Hughes G, Simms I, Ison C, Alexander S, White PJ, Ward H. Challenges Presented by Re-Emerging Sexually Transmitted Infections in HIV Positive Men who have Sex with Men: An Observational Study of Lymphogranuloma Venereum in the UK. JOURNAL OF AIDS & CLINICAL RESEARCH 2014; 5:1000329. [PMID: 26301124 PMCID: PMC4544700 DOI: 10.4172/2155-6113.1000329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND United Kingdom has reported the largest documented outbreak of lymphogranuloma venereum (LGV), a re-emerging sexually transmitted infection (STI) which is primarily seen in HIV-positive men who have sex with men (MSM). A diagnostic service was established in response to the outbreak linked to a voluntary LGV Enhanced Surveillance system. We examined the performance of this novel surveillance system to identify utility in tracking a re-emerging infection. METHODS We described laboratory data on samples and surveillance data from case reports for LGV from 2004-2010. We performed a cross-sectional analysis comparing clinical and behavioural characteristics of HIV-positive and HIV-negative/unknown LGV cases diagnosed in MSM using multivariable logistic regression models with generalised estimating equations to control for repeat infections. RESULTS LGV Surveillance data were available for 87% (1,370/1,581) of LGV cases (after de-duplication). There were 1,342 episodes in 1,281 MSM, most of whom were known to be HIV-positive (1,028/1,281, 80.2%,). HIV-positive men reported a shorter duration of symptoms (aOR 0.5; 95%CI 0.3, 0.8 for reporting more than a week compared to a week or less) in comparison to HIV-negative/unknown MSM, and were more likely to report unprotected receptive anal intercourse (aOR 2.7; 95% CI 1.3, 5.8). CONCLUSION The surveillance identified the population at greater risk of infection based on higher levels of risk behaviour in HIV-positive LGV cases. However, there was diagnostic bias towards HIV-positive LGV cases who presented with a shorter duration of symptoms when compared to HIV-negative/unknown LGV cases.
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Affiliation(s)
- Minttu Rönn
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Gwenda Hughes
- STI Section at the Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Ian Simms
- STI Section at the Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Cathy Ison
- Sexually Transmitted Bacteria Reference Unit, Public Health England, London, UK
| | - Sarah Alexander
- Sexually Transmitted Bacteria Reference Unit, Public Health England, London, UK
| | - Peter J White
- MRC Centre for Outbreak Analysis and Modelling and NIHR Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
- Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Helen Ward
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
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Heiligenberg M, Verweij SP, Speksnijder AGCL, Morré SA, de Vries HJC, Schim van der Loeff MF. No evidence for LGV transmission among heterosexuals in Amsterdam, the Netherlands. BMC Res Notes 2014; 7:355. [PMID: 24915990 PMCID: PMC4120738 DOI: 10.1186/1756-0500-7-355] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 04/29/2014] [Indexed: 11/29/2022] Open
Abstract
Background In recent years a few cases of lymphogranuloma venereum (LGV) in heterosexuals in Europe have been reported. It is not known whether LGV transmission among heterosexuals occurs on a wider scale. Methods Heterosexual male and female STI clinic clients (n = 587) in Amsterdam, the Netherlands, with a positive nucleic acid amplification test (NAAT) result for Chlamydia trachomatis (CT) were screened for IgA anti-MOMP in serum. If the value was above the cut-off index (2.0) the patient’s CT positive urogenital, ocular or rectal sample(s) were selected and tested for LGV by an in-house LGV-specific NAAT. Results Sera of 126 patients were above 2.0 COI. Some patients had >1 CT positive sample. Samples could not be retrieved from 15 of the 126 persons, and 7 samples that were found positive for CT in the diagnostic amplification process could not be confirmed and hence not typed. We did not find a single case of LGV infection in 123 urogenital, ocular or rectal samples from 104 patients. Conclusion We found no indications for significant spread of LGV infection in heterosexuals in Amsterdam. Surveillance in females with cervical or anal CT infection is indicated to monitor LGV occurrence in heterosexuals.
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Foschi C, Marangoni A, D'Antuono A, Nardini P, Compri M, Bellavista S, Filippini A, Bacchi Reggiani ML, Cevenini R. Prevalence and predictors of Lymphogranuloma venereum in a high risk population attending a STD outpatients clinic in Italy. BMC Res Notes 2014; 7:225. [PMID: 24716676 PMCID: PMC3984434 DOI: 10.1186/1756-0500-7-225] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 04/04/2014] [Indexed: 11/10/2022] Open
Abstract
Background We evaluated LGV prevalence and predictors in a high risk population attending a STI Outpatients Clinic in the North of Italy. Methods A 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. Results L2 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). Conclusions Even 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.
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Affiliation(s)
| | - Antonella Marangoni
- Microbiology, DIMES, University of Bologna, St, Orsola Hospital, Via Massarenti, 9, 40138 Bologna, Italy.
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de Vries H, Zingoni A, Kreuter A, Moi H, White J. 2013 European guideline on the management of lymphogranuloma venereum. J Eur Acad Dermatol Venereol 2014; 29:1-6. [DOI: 10.1111/jdv.12461] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 02/14/2014] [Indexed: 11/28/2022]
Affiliation(s)
- H.J.C. de Vries
- STI Outpatient Clinic; Cluster Infectious Diseases, Public Health Service Amsterdam; Amsterdam The Netherlands
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
- Centre for Infectious Diseases and Immunology Amsterdam (CINIMA); Amsterdam The Netherlands
- Centre for Infectious Disease Control; National Institute of Public Health and the Environment; Bilthoven The Netherlands
| | - A. Zingoni
- Department of Biomedical Sciences and Human Oncology; Dermatologic Clinic; University of Turin; Turin Italy
| | - A. Kreuter
- Department of Dermatology, Venereology, and Allergology; HELIOS St. Elisabeth Hospital; Oberhausen Germany
| | - H. Moi
- Olafia Clinic; Oslo university Hospital; Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - J.A. White
- Department of Genitourinary Medicine; Guy's and St Thomas' NHS Foundation Trust; London UK
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de Vrieze NHN, de Vries HJC. Lymphogranuloma venereum among men who have sex with men. An epidemiological and clinical review. Expert Rev Anti Infect Ther 2014; 12:697-704. [PMID: 24655220 DOI: 10.1586/14787210.2014.901169] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lymphogranuloma venereum (LGV) is a sexually transmitted infection, previously only seen in tropical regions. This changed in 2003 when the first endemically acquired LGV cases were reported in Rotterdam, the Netherlands, among predominantly HIV positive men who have sex with men (MSM). Early diagnosis is important to prevent irreversible complications and to stop further transmission in the community. In contrast to earlier reports, approximately 25% of LGV infections are asymptomatic and form an easily missed undetected reservoir. The majority of reported infections in MSM are found in the anorectal canal and not urogenital, which leaves the mode of transmission within the MSM network unclear. Given the increasing trend, the LGV endemic is clearly not under control. Therefore directed screening must be intensified.
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Macdonald N, Sullivan AK, French P, White JA, Dean G, Smith A, Winter AJ, Alexander S, Ison C, Ward H. Risk factors for rectal lymphogranuloma venereum in gay men: results of a multicentre case-control study in the U.K. Sex Transm Infect 2014; 90:262-8. [PMID: 24493859 PMCID: PMC4033107 DOI: 10.1136/sextrans-2013-051404] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective To identify risk factors for rectal lymphogranuloma venereum (rLGV) in men who have sex with men (MSM). Design A case-control study at 6 UK hospitals compared MSM with rLGV (cases) with rLGV-negative controls: MSM without potential rLGV symptoms (CGa) and separately, MSM with such symptoms (CGs). Methods Between 2008 and 2010, there were 90 rLGV cases, 74 CGa and 69 CGs recruited. Lifestyles and sexual behaviours in the previous 3 months were reported using internet-based computer-assisted self-interviews. Logistic regression was used to investigate factors associated with rLGV. Results Cases were significantly more likely to be HIV-positive (89%) compared with CGa (46%) and CGs (64%). Independent behavioural risks for rLGV were: unprotected receptive anal intercourse (adjusted OR (AOR)10.7, 95% CI 3.5 to 32.8), fisting another (AOR=6.7, CI 1.8 to 25.3), sex under the influence of gamma-hydroxybutyrate (AOR=3.1, CI 1.3 to 7.4) and anonymous sexual contacts (AOR=2.7, CI 1.2 to 6.3), compared with CGa; unprotected insertive anal intercourse (AOR=4.7, CI 2.0 to 10.9) and rectal douching (AOR=2.9 CI 1.3 to 6.6), compared with CGs. An incubation period from exposure to symptoms of 30 days was indicated. Conclusions Unprotected receptive anal intercourse is a key risk factor for rectal LGV with the likelihood that rectal-to-rectal transmission is facilitated where insertive anal sex also occurs. The association between HIV and rLGV appears linked to HIV-positive men seeking unprotected sex with others with the same HIV status, sexual and drug interests. Such men should be targeted for frequent STI screening and interventions to minimise associated risks.
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Affiliation(s)
- N Macdonald
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - A K Sullivan
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - P French
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - J A White
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - G Dean
- Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
| | - A Smith
- Jefferiss Wing Centre for Sexual Health, Imperial College Healthcare NHS Trust, London, UK
| | - A J Winter
- Sandyford Sexual Health Services, Glasgow, UK
| | - S Alexander
- Sexually Transmitted Bacterial Reference Unit, Public Health England, London, UK
| | - C Ison
- Sexually Transmitted Bacterial Reference Unit, Public Health England, London, UK
| | - H Ward
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
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Templeton DJ, Read P, Varma R, Bourne C. Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence. Sex Health 2014; 11:217-29. [DOI: 10.1071/sh14003] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 02/09/2014] [Indexed: 01/07/2023]
Abstract
Men who have sex with men (MSM) in Australia and overseas are disproportionately affected by sexually transmissible infections (STIs), including HIV. Many STIs are asymptomatic, so regular testing and management of asymptomatic MSM remains an important component of effective control. We reviewed articles from January 2009–May 2013 to inform the 2014 update of the 2010 Australian testing guidelines for asymptomatic MSM. Key changes include: a recommendation for pharyngeal chlamydia (Chlamydia trachomatis) testing, use of nucleic acid amplification tests alone for gonorrhoea (Neisseria gonorrhoeae) testing (without gonococcal culture), more frequent (up to four times a year) gonorrhoea and chlamydia testing in sexually active HIV-positive MSM, time required since last void for chlamydia first-void urine collection specified at 20 min, urethral meatal swab as an alternative to first-void urine for urethral chlamydia testing, and the use of electronic reminders to increase STI and HIV retesting rates among MSM.
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de Vries HJC, Zingoni A, White JA, Ross JDC, Kreuter A. 2013 European Guideline on the management of proctitis, proctocolitis and enteritis caused by sexually transmissible pathogens. Int J STD AIDS 2013; 25:465-74. [PMID: 24352129 DOI: 10.1177/0956462413516100] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 10/21/2013] [Indexed: 11/17/2022]
Abstract
Proctitis is defined as an inflammatory syndrome of the distal 10-12 cm of the anal canal, also called the rectum. Infectious proctitis can be sexually transmitted via genital-anal mucosal contact, but some also via mutual masturbation.N. gonorrhoeae,C. trachomatis(including lymphogranuloma venereum), Herpes Simplex Virus andT. pallidumare the most common sexually transmitted anorectal pathogens. Shigellosis can be transferred via oral-anal contact and may lead to proctocolitis or enteritis. Although most studies on these infections have concentrated on men who have sex with men (MSM), a significant proportion of women have anal intercourse and therefore may also be at risk. A presumptive clinical diagnosis of proctitis can be made when there are symptoms and signs, and a definitive diagnosis when the results of laboratory tests are available. The symptoms of proctitis include anorectal itching, pain, cramps (tenesmus) and discharge in and around the anal canal. Asymptomatic proctitis occurs frequently and can only be detected by laboratory tests. The majority of rectal chlamydia and gonococcal infections are asymptomatic. Therefore when there is a history of receptive anal contact, exclusion of anorectal infections is generally indicated as part of standard screening for sexually transmitted infections (STIs). Condom use does not guarantee protection from bacterial and protozoan STIs, which are often spread without penile penetration.
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Affiliation(s)
- Henry J C de Vries
- STI outpatient clinic, Cluster Infectious Diseases, Health Service Amsterdam, Amsterdam, The Netherlands Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Centre for Infectious Diseases and Immunology Amsterdam (CINIMA), Amsterdam, The Netherlands Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Adele Zingoni
- Department of Biomedical Sciences and Human Oncology, Dermatologic Clinic, University of Turin, Turin, Italy
| | - John A White
- Department of Genitourinary Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jonathan D C Ross
- Sexual Health Clinic - University Hospitals Birmingham NHS Foundation Trust, Whittall Street Clinic, Birmingham, UK
| | - Alexander Kreuter
- Department of Dermatology, Venereology, and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, Germany
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