1
|
Cannoni G, Ribbeck D, Hernández O, Casacuberta MJ. Actualización de la infección por Chlamydia trachomatis en mujeres. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [DOI: 10.1016/j.rmclc.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
2
|
Blanco JL, Fuertes I, Bosch J, De Lazzari E, Gonzalez-Cordón A, Vergara A, Blanco-Arevalo A, Mayans J, Inciarte A, Estrach T, Martinez E, Cranston RD, Gatell JM, Alsina-Gibert M. Effective treatment of Lymphogranuloma venereum proctitis with Azithromycin. Clin Infect Dis 2021; 73:614-620. [PMID: 33462582 DOI: 10.1093/cid/ciab044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by Chlamydia trachomatis (CT) serovars L1, L2, and L3 and is endemic among men who have sex with men (MSM) in Europe. We evaluated weekly oral Azithromycin 1 g for 3 weeks as a treatment for LGV proctitis. METHODS This is an open clinical trial with convenience allocation according to treating physician preferences. Adults with clinical proctitis received a single dose of 1 g of intramuscular ceftriaxone and were subsequently allocated to receive (i) Doxycycline 100 mg twice daily for 21 days (Doxycycline-group) or, (ii) Azithromycin 1 g orally once weekly for 3 weeks (Azithromycin-group). LGV-cure, (primary endpoint) was defined as resolution of symptoms at week 6 (clinical cure, LGV-CC), with an additional supporting negative rectal PCR at week 4 (microbiological cure; LGV-MC), if available. FINDINGS One hundred and twenty-five individuals with LGV clinical proctitis were included. All were MSM and 96% were HIV-positive. Eighty-two were in the Azithromycin-group and 43 in the Doxycycline-group. LGV-cure on a modified intention-to-treat analysis (primary endpoint), occurred in 80 of 82 (98%) in the Azithromycin-group versus 41 of 43 (95%) in Doxycycline-group [treatment difference (95% CI) 2.2% (-3.2; 13.2)]. LGV-MC occurred in 70 of 72 (97%) vs 15 of 15 (100%) in Azithromycin-group and Doxycycline-group, respectively [treatment difference (95% CI) -2.8% (-9.6; 17.7)]. Adverse events were similar in both treatment groups. INTERPRETATION Our findings support extended azithromycin dosing as an alternative treatment option for symptomatic LGV proctitis and provides the rationale for future randomized trials.
Collapse
Affiliation(s)
- José L Blanco
- Infectious Diseases Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Irene Fuertes
- Dermatology Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Jordi Bosch
- Microbiology Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Elisa De Lazzari
- Infectious Diseases Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Ana Gonzalez-Cordón
- Infectious Diseases Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Andrea Vergara
- Microbiology Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Alejandro Blanco-Arevalo
- Infectious Diseases Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Josep Mayans
- Infectious Diseases Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Alexy Inciarte
- Infectious Diseases Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Teresa Estrach
- Microbiology Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Esteban Martinez
- Infectious Diseases Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Ross D Cranston
- Infectious Diseases Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Josep M Gatell
- Honorary Professor of Medicine. University of Barcelona. Senior Global Medical Director. ViiV Healthcare Barcelona. Spain
| | - Merce Alsina-Gibert
- Dermatology Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Leeyaphan C, Ong JJ, Chow EPF, Dimovski K, Kong FYS, Hocking JS, Howden B, Bissessor M, Fairley CK, Bradshaw C, Read T, Chen M. Treatment Outcomes for Rectal Lymphogranuloma Venereum in Men Who Have Sex with Men Using Doxycycline, Azithromycin, or Both: A Review of Clinical Cases. Sex Transm Dis 2017; 44:245-248. [PMID: 28282652 DOI: 10.1097/olq.0000000000000578] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Treatment for rectal lymphogranuloma venereum where doxycycline 100 mg twice daily for 21 days was used-either alone or together with azithromycin 1 g single dose-resulted in microbiological cure of 97%. These data support doxycycline 100 mg twice daily for 21 days as the preferred treatment for rectal lymphogranuloma venereum.
Collapse
Affiliation(s)
- Charussri Leeyaphan
- From the *Melbourne Sexual Health Centre, Alfred Health, Carlton, Melbourne, Victoria, Australia; †Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; ‡Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne; §Microbiological Diagnostic Unit Public Health Laboratory, University of Melbourne, Parkville; and ¶Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
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: 23] [Impact Index Per Article: 2.9] [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.
Collapse
|
6
|
Stoner BP, Cohen SE. Lymphogranuloma Venereum 2015: Clinical Presentation, Diagnosis, and Treatment. Clin Infect Dis 2016; 61 Suppl 8:S865-73. [PMID: 26602624 DOI: 10.1093/cid/civ756] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Lymphogranuloma venereum (LGV) has emerged as an important cause of proctitis and proctocolitis in men who have sex with men; classical inguinal presentation is now increasingly uncommon. We report summary findings of an extensive literature review on LGV clinical presentation, diagnosis, and treatment that form the evidence base for the 2015 Centers for Disease Control and Prevention treatment guidelines for sexually transmitted diseases. Proctitis and proctocolitis are now the most commonly reported clinical manifestations of LGV, with symptoms resembling those of inflammatory bowel disease. Newer molecular tests to confirm LGV infection are sensitive and specific, but are generally restricted to research laboratory or public health settings. Doxycycline (100 mg twice daily for 21 days) remains the treatment of choice for LGV. Patients with rectal chlamydial infection and signs or symptoms of proctitis should be tested for LGV, or if confirmatory testing is not available, should be treated empirically with a recommended regimen to cover LGV infection.
Collapse
Affiliation(s)
- Bradley P Stoner
- Department of Anthropology and Division of Infectious Diseases, Washington University, St Louis, Missouri
| | - Stephanie E Cohen
- San Francisco Department of Public Health Division of Infectious Diseases, University of California, San Francisco
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
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
| |
Collapse
|
9
|
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: 109] [Impact Index Per Article: 10.9] [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.
Collapse
|
10
|
White J, O’Farrell N, Daniels D. 2013 UK National Guideline for the management of lymphogranuloma venereum. Int J STD AIDS 2013; 24:593-601. [PMID: 23970591 DOI: 10.1177/0956462413482811] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- John White
- Department of Genitourinary medicine, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
| | | | | |
Collapse
|