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Oda G, Chung J, Lucero-Obusan C, Holodniy M. Clinically Defined Lymphogranuloma Venereum among US Veterans with Human Immunodeficiency Virus, 2016-2023. Microorganisms 2024; 12:1327. [PMID: 39065095 PMCID: PMC11278903 DOI: 10.3390/microorganisms12071327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024] Open
Abstract
We applied lymphogranuloma venereum (LGV) clinical case criteria to a cohort of 1381 Veterans positive for HIV and Chlamydia trachomatis (CT) from 2016 from 2023 and analyzed variables to ascertain risk factors for LGV and factors associated with the use of standard treatment regimens. In total, 284/1381 (20.6%) met the criteria for LGV. A total of 179/284 (63%) were probable cases, and 105/284 (37%) were possible cases (those meeting clinical criteria but with concurrent sexually transmitted infections (STI) associated with LGV-like symptoms). None had confirmatory CT L1-L3 testing. A total of 230 LGV cases (81%) presented with proctitis, 71 (25%) with ulcers, and 57 (20.1%) with lymphadenopathy. In total, 66 (23.2%) patients had >1 symptom of LGV. A total of 43 (15%) LGV cases were hospitalized. Primary risk factors for LGV were male birth sex (p = 0.004), men who have sex with men (p < 0.001), and the presence of STIs other than gonorrhea or syphilis (p = 0.011). In total, 124/284 (43.7%) LGV cases received standard recommended treatment regimens. Probable cases were more likely to receive standard treatment than possible cases (p = 0.003). We report that 20.6% of CT cases met clinical criteria for LGV among HIV-infected Veterans and that less than half of cases received recommended treatment regimens, indicating that LGV is likely underestimated and inadequately treated among this US population.
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Affiliation(s)
- Gina Oda
- Public Health National Program Office, Department of Veterans Affairs, Washington, DC 20420, USA; (J.C.); (C.L.-O.); (M.H.)
| | - Joyce Chung
- Public Health National Program Office, Department of Veterans Affairs, Washington, DC 20420, USA; (J.C.); (C.L.-O.); (M.H.)
| | - Cynthia Lucero-Obusan
- Public Health National Program Office, Department of Veterans Affairs, Washington, DC 20420, USA; (J.C.); (C.L.-O.); (M.H.)
| | - Mark Holodniy
- Public Health National Program Office, Department of Veterans Affairs, Washington, DC 20420, USA; (J.C.); (C.L.-O.); (M.H.)
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA 94305, USA
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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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Gravett RM, Marrazzo J. What’s Old Is New: the Evolution of Lymphogranuloma Venereum Proctitis in Persons Living with HIV. Curr Infect Dis Rep 2022. [DOI: 10.1007/s11908-022-00781-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Woodson EN, Katz SS, Mosley SS, Danavall DC, Bowden KE, Chi KH, Raphael BH. Use of real-time PCR as an alternative to conventional genotyping methods for the laboratory detection of lymphogranuloma venereum (LGV). Diagn Microbiol Infect Dis 2021; 101:115532. [PMID: 34571353 DOI: 10.1016/j.diagmicrobio.2021.115532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/20/2021] [Accepted: 08/21/2021] [Indexed: 11/26/2022]
Abstract
Lymphogranuloma venereum (LGV) can be differentiated from non-LGV chlamydial infection using Sanger sequencing or molecular assays, including those that are commercially-available internationally. Here, we describe the performance of a rapid real-time PCR (RT-PCR)-based strategy in differentiating Chlamydia trachomatis infections associated with LGV or non-LGV serovars. One hundred three rectal swabs, previously genotyped using Sanger sequencing of the ompA gene as a reference method, were tested in the RT-PCR assays. All non-LGV specimens were correctly identified, but the RT-PCR failed to detect 1 LGV specimen, resulting in a sensitivity of 87.5% for the non-LGV/LGV RT-PCR assay. Additional performance characteristics (e.g., specificity, accuracy, and reproducibility) were all between 93% and 100% with a limit of detection ≤100 copies/reaction. Thus, this rapid RT-PCR method for LGV detection in clinical specimens is comparable to the reference method.
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Affiliation(s)
- Evonne N Woodson
- Laboratory Leadership Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; Division of STD Prevention, National Center for HIV, Hepatitis, STD, TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Samantha S Katz
- Division of STD Prevention, National Center for HIV, Hepatitis, STD, TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sheree S Mosley
- Division of STD Prevention, National Center for HIV, Hepatitis, STD, TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Damien C Danavall
- Division of STD Prevention, National Center for HIV, Hepatitis, STD, TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Katherine E Bowden
- Division of STD Prevention, National Center for HIV, Hepatitis, STD, TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kai-Hua Chi
- Division of STD Prevention, National Center for HIV, Hepatitis, STD, TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brian H Raphael
- Division of STD Prevention, National Center for HIV, Hepatitis, STD, TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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