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Tornero C, Frutos JM, Orta N, Lopez C, Castello I. Two Birds, One Stone: Two Unusual Causes of Diarrhea in a Nonimmunocompromised Human Immunodeficiency Virus-Infected Patient. Clin Infect Dis 2019; 67:1775-1776. [PMID: 30423036 DOI: 10.1093/cid/ciy282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carlos Tornero
- Department of Internal Medicine, Hospital Francesc De Borja Gandia, Valencia, Spain
| | - Jose Maria Frutos
- Department of Internal Medicine, Hospital Francesc De Borja Gandia, Valencia, Spain
| | - Nieves Orta
- Department of Microbiology, Hospital Francesc De Borja Gandia, Valencia, Spain
| | - Cecilia Lopez
- Department of Pathology, Hospital Francesc De Borja Gandia, Valencia, Spain
| | - Inmaculada Castello
- Department of Digestive Diseases, Hospital Francesc De Borja Gandia, Valencia, Spain
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2
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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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3
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de Barbeyrac B, Laurier-Nadalié C, Touati A, Le Roy C, Imounga L, Hénin N, Peuchant O, Bébéar C, La Ruche G, Ndeikoundam Ngangro N. Observational study of anorectal Chlamydia trachomatis infections in France through the lymphogranuloma venereum surveillance network, 2010-2015. Int J STD AIDS 2018; 29:1215-1224. [PMID: 29973128 DOI: 10.1177/0956462418785266] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The objective of this article is to describe the epidemiology of lymphogranuloma venereum (LGV) and non-LGV Chlamydia trachomatis anorectal infections in France and to examine the characteristics of the affected populations via a voluntary sentinel surveillance system for LGV between 2010 and 2015. Anorectal samples positive for C. trachomatis (CT) were sent by the participating laboratories to the National Reference Center for CT for LGV identification. Biological and clinical data were collected by biologists and clinicians. There were 1740 LGV episodes and 2248 non-LGV episodes. Continuous monitoring highlighted a sharp increase in the number of LGV and non-LGV anorectal infections, which were 2.3-fold and 6.5-fold, respectively. Most of the infections occurred in men who have sex with men. LGV patients were older than non-LGV patients and were more frequently human immunodeficiency virus (HIV)-positive compared to non-LGV patients. Anorectal LGV was significantly associated with residence in Paris, HIV co-infection, concurrent syphilis and bloody anal discharge. Undocumented patient characteristics were strongly associated with anorectal LGV. The anorectal LGV epidemic is poorly controlled in France. Early detection and prompt treatment of patients and their sexual partners are required to prevent transmission in the context of pre-exposure prophylaxis (PrEP) for HIV infection.
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Affiliation(s)
- B de Barbeyrac
- 1 Mycoplasmal and Chlamydial Infections in Humans, University of Bordeaux, Bordeaux, France.,2 Mycoplasmal and Chlamydial Infections in Humans, INRA, Bordeaux, France.,3 Centre Hospitalier Universitaire de Bordeaux, Laboratoire de Bactériologie, French National Reference Center for bacterial STIs, Bordeaux, France
| | - C Laurier-Nadalié
- 1 Mycoplasmal and Chlamydial Infections in Humans, University of Bordeaux, Bordeaux, France.,2 Mycoplasmal and Chlamydial Infections in Humans, INRA, Bordeaux, France.,3 Centre Hospitalier Universitaire de Bordeaux, Laboratoire de Bactériologie, French National Reference Center for bacterial STIs, Bordeaux, France
| | - A Touati
- 1 Mycoplasmal and Chlamydial Infections in Humans, University of Bordeaux, Bordeaux, France.,2 Mycoplasmal and Chlamydial Infections in Humans, INRA, Bordeaux, France.,3 Centre Hospitalier Universitaire de Bordeaux, Laboratoire de Bactériologie, French National Reference Center for bacterial STIs, Bordeaux, France
| | - C Le Roy
- 1 Mycoplasmal and Chlamydial Infections in Humans, University of Bordeaux, Bordeaux, France.,2 Mycoplasmal and Chlamydial Infections in Humans, INRA, Bordeaux, France.,3 Centre Hospitalier Universitaire de Bordeaux, Laboratoire de Bactériologie, French National Reference Center for bacterial STIs, Bordeaux, France
| | - L Imounga
- 1 Mycoplasmal and Chlamydial Infections in Humans, University of Bordeaux, Bordeaux, France.,2 Mycoplasmal and Chlamydial Infections in Humans, INRA, Bordeaux, France.,3 Centre Hospitalier Universitaire de Bordeaux, Laboratoire de Bactériologie, French National Reference Center for bacterial STIs, Bordeaux, France
| | - N Hénin
- 1 Mycoplasmal and Chlamydial Infections in Humans, University of Bordeaux, Bordeaux, France.,2 Mycoplasmal and Chlamydial Infections in Humans, INRA, Bordeaux, France.,3 Centre Hospitalier Universitaire de Bordeaux, Laboratoire de Bactériologie, French National Reference Center for bacterial STIs, Bordeaux, France
| | - O Peuchant
- 1 Mycoplasmal and Chlamydial Infections in Humans, University of Bordeaux, Bordeaux, France.,2 Mycoplasmal and Chlamydial Infections in Humans, INRA, Bordeaux, France.,3 Centre Hospitalier Universitaire de Bordeaux, Laboratoire de Bactériologie, French National Reference Center for bacterial STIs, Bordeaux, France
| | - C Bébéar
- 1 Mycoplasmal and Chlamydial Infections in Humans, University of Bordeaux, Bordeaux, France.,2 Mycoplasmal and Chlamydial Infections in Humans, INRA, Bordeaux, France.,3 Centre Hospitalier Universitaire de Bordeaux, Laboratoire de Bactériologie, French National Reference Center for bacterial STIs, Bordeaux, France
| | - G La Ruche
- 4 Santé Publique France (the French National Public Health Agency), Saint-Maurice, France
| | - N Ndeikoundam Ngangro
- 4 Santé Publique France (the French National Public Health Agency), Saint-Maurice, France
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4
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Peuchant O, Touati A, Sperandio C, Hénin N, Laurier-Nadalié C, Bébéar C, de Barbeyrac B. Changing Pattern of Chlamydia trachomatis Strains in Lymphogranuloma Venereum Outbreak, France, 2010-2015. Emerg Infect Dis 2018; 22:1945-1947. [PMID: 27767927 PMCID: PMC5088033 DOI: 10.3201/eid2211.160247] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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
We describe a change in the molecular epidemiology of Chlamydia trachomatis strains involved in an outbreak of rectal lymphogranuloma venereum in France during January 2010-April 2015. Until 2012, the C. trachomatis L2b strain predominated; however, starting in 2013, most cases involved the L2 strain. We also identified 4 genetic L2b ompA variants.
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Kubo T, Ishida K, Matsuo J, Nakamura S, Hayashi Y, Sakai H, Yoshida M, Takahashi K, Hirai I, Yamamoto Y, Yamaguchi H. Chlamydia trachomatis serovar L2 infection model using human lymphoid Jurkat cells. Microb Pathog 2012; 53:1-11. [DOI: 10.1016/j.micpath.2012.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 02/18/2012] [Accepted: 02/23/2012] [Indexed: 01/02/2023]
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6
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Rönn MM, Ward H. The association between lymphogranuloma venereum and HIV among men who have sex with men: systematic review and meta-analysis. BMC Infect Dis 2011; 11:70. [PMID: 21418569 PMCID: PMC3070636 DOI: 10.1186/1471-2334-11-70] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 03/18/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lymphogranuloma venereum (LGV) is an important re-emerging sexually transmitted infection which is reported to affect particularly HIV-positive men who have sex with men (MSM). The aim of this study is to quantify the association between LGV and HIV in the context of the current emergence of LGV. METHODS A systematic review was performed on the emergence of LGV among MSM since 2000. We report the prevalence of HIV infection from descriptive studies of MSM with LGV, and conduct a meta-analysis to produce a summary estimate of the association between LGV and HIV from case-control studies where cases were MSM with LGV and controls were MSM with rectal chlamydia caused by non-LGV serovars. RESULTS The prevalence of HIV among LGV cases ranges from 67% to 100% in 13 descriptive studies. There is a significant association between HIV and LGV (odds ratio 8.19, 95% CI 4.68-14.33). CONCLUSIONS HIV-positive MSM are disproportionately affected by LGV highlighting the importance of prevention efforts to be targeted to this group. Further research is needed to determine whether the association is due to biological or behavioural factors.
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Affiliation(s)
- Minttu M Rönn
- Department of Infectious Disease Epidemiology, Imperial College London, Old Medical School, St. Mary's Campus, Norfolk Place, Paddington, W2 1PG London, UK
| | - Helen Ward
- Department of Infectious Disease Epidemiology, Imperial College London, Old Medical School, St. Mary's Campus, Norfolk Place, Paddington, W2 1PG London, UK
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7
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Martin-Iguacel R, Llibre JM, Nielsen H, Heras E, Matas L, Lugo R, Clotet B, Sirera G. Lymphogranuloma venereum proctocolitis: a silent endemic disease in men who have sex with men in industrialised countries. Eur J Clin Microbiol Infect Dis 2010; 29:917-25. [PMID: 20509036 DOI: 10.1007/s10096-010-0959-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Accepted: 05/06/2010] [Indexed: 10/19/2022]
Abstract
Lymphogranuloma venereum (LGV) is a sexually transmitted disease (STD) caused by serovars L1-L3 of Chlamydia trachomatis. Rare in the western world prior to 2003, different outbreaks or clusters of LGV have been reported in Europe, North America and Australia among men who have sex with men (MSM) over the past few years. The majority were HIV infected MSM with high-risk sexual behaviour and a high rate of concomitant STD, including hepatitis C. Most of them presented with a proctitis syndrome and only a few with the classical bubonic form. A previously non-described serovar, L2b, has been identified as the main causative agent of the epidemic. A delay in diagnosis has been the rule because of the misleading symptomatology of LGV proctitis, the unfamiliarity of the disease to physicians, and the lack of a routine diagnostic test for LGV serovars. It is crucial to increase the awareness of the disease among physicians for prompt diagnosis and treatment, to avoid complications, and to stop ongoing transmission. It has additional public health implications since LGV may facilitate the transmission and acquisition of HIV and other STD.
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Affiliation(s)
- R Martin-Iguacel
- Department of Infectious Diseases, Aalborg Hospital, Aarhus University Hospital, Hobrovej 18, Aalborg, Denmark.
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8
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Pathela P, Blank S, Schillinger JA. Lymphogranuloma venereum: old pathogen, new story. Curr Infect Dis Rep 2010; 9:143-50. [PMID: 17324352 DOI: 10.1007/s11908-007-0010-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Lymphogranuloma venerum (LGV), an ulcerative sexually transmitted infection caused by the L serovars of Chlamydia trachomatis, has gained recent attention as a cause of hemorrhagic proctitis among men who have sex with men in North America, the United Kingdom, and Europe. It has been a rare diagnosis, and likely has not been included in the routine differential diagnosis for proctocolitis. The lack of a specific diagnostic test has complicated LGV case ascertainment. In the absence of laboratory confirmation of L serovars, physicians are advised to treat possible cases presumptively for LGV and provide medical management of sexual partners. The appearance of an ulcerative infection in sexual networks with high rates of HIV coinfection may forewarn of increased HIV transmission; interruption of disease transmission remains a priority for medical providers and the public health community.
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Affiliation(s)
- Preeti Pathela
- Bureau of Sexually Transmitted Disease Control, New York City Department of Health and Mental Hygiene, 125 Worth Street, Room 207, CN 73, New York, NY 10013, USA.
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Abstract
Chlamydia trachomatis infections affect young, sexually active persons. Risk factors include multiple partners and failure to use condoms. The incidence of infection has increased in the past 10 years. Untreated C. trachomatis infections are responsible for a large proportion of salpingitis, ectopic pregnancy, infertility and, to a lesser extent, epididymitis. Screening is a possible intervention to control the infection, which is often asymptomatic. The emergence of lymphogranuloma venereum proctitis in men who have sex with men, in Europe, and of a variant with a deletion in the cryptic plasmid, in Sweden, are new features of C. trachomatis infections in the last years. A diagnosis is best made by using nucleic acid amplification tests, because they perform well and do not require invasive procedures for specimen collection. Single-dose therapy has been a significant development for treatment of an uncomplicated infection of the patient and his or her sexual partner.
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Affiliation(s)
- C Bébéar
- Laboratoire de Bactériologie EA 3671, Infections Humaines à Mycoplasmes et Chlamydiae, CNR des Infections à Chlamydiae, Université Victor Segalen Bordeaux 2, Bordeaux, France.
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Abstract
PURPOSE OF REVIEW This review was prompted by a sustained outbreak of lymphogranuloma venereum that has been observed among men who have sex with men (MSM) worldwide since 2004. Recent developments in the epidemiology, diagnosis and management of the infection are summarized. RECENT FINDINGS Between the early 1980s and 2003, lymphogranuloma venereum was rarely seen in the developed world. In 2003, a cluster of cases was seen in the Netherlands occurring mostly in HIV-positive MSM with high levels of sexual risk. With the assistance of novel molecular diagnostic techniques, more than a thousand cases of Chlamydia trachomatis L2 serovar disease have now been reported in MSM worldwide. Almost all have presented with rectal infection, usually manifesting as severe proctitis, with ulcer adenopathy syndrome seldom seen. Oral doxycycline remains the recommended treatment and has proven effective in the recent outbreak. Conflicting data exist regarding the prevalence of asymptomatic infection, and our understanding of the exact modes of transmission remains incomplete. SUMMARY Lymphogranuloma venereum appears to have reestablished endemicity among MSM populations in many industrialized nations. In the relative absence of recent publications from its traditional endemic regions it can be assumed that these populations remain afflicted by the infection as well.
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Tinmouth J, Gilmour MW, Kovacs C, Kropp R, Mitterni L, Rachlis A, Richards S, Salit I, Sikri R, Valencia GR, Wesson T, Wong T, Wood H. Is there a reservoir of sub-clinical lymphogranuloma venereum and non-LGV Chlamydia trachomatis infection in men who have sex with men? Int J STD AIDS 2009; 19:805-9. [PMID: 19050208 DOI: 10.1258/ijsa.2008.008260] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
SUMMARY The aim of this study was to determine if a reservoir of sub-clinical LGV infection exists in men who have sex with men (MSM), as this finding might account for the recent rise in lymphogranuloma venereum (LGV) Chlamydia trachomatis infections among MSM in Canada. MSM without proctitis were enrolled between January and August 2006 in a cross-sectional study. Rectal, urine, serology and pharyngeal specimens were tested for specific C. trachomatis serovars. The median age of the 253 participants was 43 years; 53% were HIV+. We found no active cases of LGV infection; but 20 (8%) participants had positive serology. Thirteen participants (5%) had non-LGV C. trachomatis infections. Unprotected anopenetrative intercourse, rectal enema and drug use were associated with non-LGV C. trachomatis infection. Sub-clinical rectal non-LGV C. trachomatis infection was relatively common but LGV was not identified in our sample. Further studies of screening for non-LGV chlamydia infection in MSM are needed.
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Affiliation(s)
- J Tinmouth
- Department of Medicine Sunnybrook Health Sciences Centre, Division of Gastroenterology, Toronto, Ontario, Canada.
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13
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New Chlamydia trachomatis L2 Strains Identified in a Recent Outbreak of Lymphogranuloma Venereum in Vienna, Austria. Sex Transm Dis 2008; 35:377-82. [DOI: 10.1097/olq.0b013e31815d6df8] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Dougan S, Evans BG, Elford J. Sexually transmitted infections in Western Europe among HIV-positive men who have sex with men. Sex Transm Dis 2008; 34:783-90. [PMID: 17495592 DOI: 10.1097/01.olq.0000260919.34598.5b] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Since 1996, there has been a resurgence in sexually transmitted infections (STIs) among men who have sex with men (MSM) in Western Europe. This has coincided with a significant decrease in HIV-associated mortality following the introduction of highly active antiretroviral therapies (HAART) and a corresponding increase in the number of MSM living with HIV. Levels of unprotected anal intercourse have also increased. In this article, we use STI surveillance data from a number of Western European countries to better understand the contribution of HIV-positive MSM to the recent increase in STIs. METHODS Published literature, surveillance reports, and ad hoc publications relating to HIV prevalence trends and STIs among HIV-positive MSM in Western Europe were reviewed. RESULTS Post-HAART, HIV prevalence among community samples of MSM ranged from 5% to 18%. HIV prevalence among MSM diagnosed with an STI was substantially higher. On average, HIV prevalence among MSM diagnosed with syphilis in 11 countries was 42% (range 14%-59%). Most HIV-positive MSM with syphilis were aware of their HIV status. In England and Wales, 32% of MSM with gonorrhea were HIV-positive in 2004. Outbreaks of lymphogranuloma venereum have been documented in 9 countries; HIV-positive MSM accounted for 75% of cases on average (range 0%-92%). Cases of sexually transmitted hepatitis C have been predominantly identified among HIV-positive MSM in Rotterdam, Paris, Amsterdam, and the United Kingdom. CONCLUSIONS In Western Europe, STIs have been disproportionately diagnosed among HIV-positive MSM post-HAART. Improved survival coupled with serosorting among HIV-positive MSM appears to explain the high prevalence of HIV among MSM with STIs. STI transmission among HIV-positive men will have contributed substantially to increasing STI trends seen among MSM in Western Europe, since 1996. These findings highlight the need for routine STI testing among HIV-positive MSM as well as safer sex messages highlighting the implications of STI coinfection.
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Affiliation(s)
- Sarah Dougan
- City University, Institute of Health Sciences, St. Bartholomew School of Nursing and Midwifery, London, United Kingdom.
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McLean CA, Stoner BP, Workowski KA. Treatment of Lymphogranuloma Venereum. Clin Infect Dis 2007; 44 Suppl 3:S147-52. [PMID: 17342667 DOI: 10.1086/511427] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Lymphogranuloma venereum (LGV) classically presents with 1 or more genital ulcers or papules, as well as inguinal lymphadenopathy (buboes). Recently reported cases of LGV proctitis in men who have sex with men, many of whom are coinfected with human immunodeficiency virus (HIV), have highlighted the importance of optimal clinical treatment of LGV. METHODS A review was conducted of the literature on LGV published between 1998 and 2004, as part of the development of the 2006 sexually transmitted disease treatment guidelines of the Centers for Disease Control and Prevention (CDC). RESULTS Doxycycline (100 mg orally twice daily for 21 days) remains the treatment of choice for LGV. No controlled trials support the use of azithromycin or the use of alternative treatment regimens for persons with HIV infection. CONCLUSIONS On the basis of the present literature review, the CDC's treatment recommendations for LGV remain unchanged. LGV clinical care, surveillance, and research are severely hindered by the lack of widely available, rapid, standardized tests for the diagnosis of LGV; therefore, patients with symptoms suggestive of LGV, including LGV proctitis, should be presumptively treated with antibacterial therapy for 3 weeks.
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Affiliation(s)
- Catherine A McLean
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (proposed), Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Pantanowitz L, Dezube BJ, Schlecht H. HIV-Associated Anorectal Lymphogranuloma Venereum: An Emerging Epidemic. HIV & AIDS REVIEW 2007. [DOI: 10.1016/s1730-1270(10)60036-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Ward H, Martin I, Macdonald N, Alexander S, Simms I, Fenton K, French P, Dean G, Ison C. Lymphogranuloma venereum in the United kingdom. Clin Infect Dis 2006; 44:26-32. [PMID: 17143811 DOI: 10.1086/509922] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Accepted: 09/11/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Over the past 2 years, lymphogranuloma venereum (LGV), caused by L serovars of Chlamydia trachomatis, has emerged as a significant problem among men who have sex with men (MSM). We report on, to our knowledge, the largest case series of LGV to date, with detailed epidemiological and clinical characteristics of the epidemic in the United Kingdom. METHODS A national diagnostic service and surveillance system was established in October 2004. Cases were confirmed by the presence of C. trachomatis and an LGV serovar (L1, L2, or L3) from genotyping. For confirmed cases, an enhanced surveillance questionnaire was sent to the clinician. RESULTS Through February 2006, a total of 327 cases of LGV were confirmed. Cases were diagnosed across the United Kingdom, with the majority from London (71%) and Brighton (13%). Case reports were received for 282 MSM. The majority (96%) had proctitis, many with severe local and systemic symptoms. There was a high level of coinfection with human immunodeficiency virus (76%), hepatitis C (19%), and other sexually transmitted infections (39%). Nine cases of human immunodeficiency virus infection were diagnosed around the same time as LGV. Most cases were acquired within the United Kingdom, although patients with early cases were more likely to report contacts in The Netherlands. CONCLUSIONS We found a significant burden of this once-rare sexually transmitted infection among MSM in the United Kingdom. LGV may be contributing to the epidemic of human immunodeficiency virus infection by facilitating transmission. Further control efforts are required, including awareness campaigns, continued detailed surveillance, and expanded chlamydia testing among MSM.
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Affiliation(s)
- Helen Ward
- HIV and STI Section, Imperial College London, London, W2 1PG, United Kingdom.
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Caumes E, Dupin N, Janier M, Chartier C, Viraben R, Bouscarat F. Lymphogranulome vénérien (maladie de Nicolas-Favre). Ann Dermatol Venereol 2006. [DOI: 10.1016/s0151-9638(06)71019-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Herida M, Kreplack G, Cardon B, Desenclos JC, de Barbeyrac B. First Case of Urethritis Due toChlamydia trachomatisGenovar L2b. Clin Infect Dis 2006; 43:268-9. [PMID: 16779763 DOI: 10.1086/505310] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Ahdoot A, Kotler DP, Suh JS, Kutler C, Flamholz R. Lymphogranuloma venereum in human immunodeficiency virus-infected individuals in New York City. J Clin Gastroenterol 2006; 40:385-90. [PMID: 16721218 DOI: 10.1097/00004836-200605000-00005] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Lymphogranuloma venereum (LGV), or chlamydial proctitis, is a classic sexually transmitted disease with prominent gastrointestinal manifestations. The disease has received little attention in recent years, especially in relation to human immunodeficiency virus (HIV) infection. However, outbreaks of LGV have been reported in several large cities in Europe and the United States over the past few years, occurring in both HIV-infected and -uninfected individuals, and the reports have been largely limited to the sexually transmitted disease literature. We recently diagnosed four cases of chlamydial proctitis in HIV-infected individuals, who had different clinical presentations but very similar endoscopic and histopathologic features, as well as prompt and complete response to therapy. It is important for gastroenterologists to recognize that LGV may be reemerging as a relevant clinical entity, because of its similarity to inflammatory bowel diseases and its response to treatment with antibiotics.
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Affiliation(s)
- Allen Ahdoot
- Gastrointestinal Division, Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY 10025, USA
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Van der Bij AK, Spaargaren J, Morré SA, Fennema HSA, Mindel A, Coutinho RA, de Vries HJC. Diagnostic and Clinical Implications of Anorectal Lymphogranuloma Venereum in Men Who Have Sex with Men: A Retrospective Case-Control Study. Clin Infect Dis 2006; 42:186-94. [PMID: 16355328 DOI: 10.1086/498904] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2005] [Accepted: 08/29/2005] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Recently, outbreaks of anorectal lymphogranuloma venereum (LGV) have occurred among men who have sex with men (MSM). This study identifies risk factors and clinical predictors of LGV to determine the implications for clinical practice. METHODS The Chlamydia trachomatis serovars for all MSM who had anorectal chlamydia diagnosed at a sexually transmitted infection clinic in Amsterdam, The Netherlands, in 2002 and 2003 were retrospectively typed; 87 persons were infected with C. trachomatis serovar L2b and received a diagnosis of LGV. MSM infected with C. trachomatis serovars A-K and who thus had non-LGV anorectal chlamydia (n = 377) and MSM who reported having receptive anorectal intercourse but who did not have anorectal chlamydia (n = 2677) served as 2 separate control groups. Risk factors and clinical predictors were analyzed by multivariate logistic regression. Receiver operating characteristic curves were used to determine clinical relevance. RESULTS HIV seropositivity was the strongest risk factor for LGV (odds ratio for patients with LGV vs. those with non-LGV chlamydia, 5.7 [95% confidence interval, 2.6-12.8]; odds ratio for patients with LGV vs. control subjects without chlamydia, 9.3 [95% confidence interval, 4.4-20.0]). Proctoscopic findings and elevated white blood cell counts in anorectal smear specimens were the only clinically relevant predictors for LGV infection (area under the curve of the receiver operating characteristic curve, > 0.71). Use of these 2 parameters and HIV infection status provided the highest diagnostic accuracy (for MSM with anorectal chlamydia, the area under the curve was > 0.82; sensitivity and specificity were 89% and 50%, respectively). CONCLUSIONS LGV testing is recommended for MSM with anorectal chlamydia. If routine LGV serovar typing is unavailable, we propose administration of syndromic LGV treatment for MSM with anorectal chlamydia and either proctitis detected by proctoscopic examination, > 10 white blood cells/high-power field detected on an anorectal smear specimen, or HIV seropositivity.
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Affiliation(s)
- Akke K Van der Bij
- Department of HIV and STD Research, Municipal Health Service of Amsterdam, Amsterdam, The Netherlands
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Sednaoui P, Monfort L, Nassar N, Pentel J, De Barbeyrac B, Halioua B. C4 - Place de la sérologie Chlamydia trachomatis dans le diagnostic de la lymphogranulomatose vénérienne anorectale. Ann Dermatol Venereol 2005. [DOI: 10.1016/s0151-9638(05)79625-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Herida M, Michel A, Goulet V, Janier M, Sednaoui P, Dupin N, de Barbeyrac B, Semaille C. L'épidémiologie des infections sexuellement transmissibles en France. Med Mal Infect 2005; 35:281-9. [PMID: 15876505 DOI: 10.1016/j.medmal.2005.03.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2005] [Accepted: 03/02/2005] [Indexed: 12/21/2022]
Abstract
BACKGROUND Sexually transmitted infections (STI) in France are reported on a voluntary basis through several sentinel surveillance systems. METHODS To monitor STI, sentinel laboratory- or clinician-based surveillance systems were set up by the Institut de Veille Sanitaire: gonorrhea surveillance (Renago) in 1986, Chlamydia infections surveillance (Renachla) in 1989, and more recently, syphilis surveillance in 2000 and rectal lymphogranuloma venereum (LGV) in 2004. RESULTS From 2000 to 2003, 1,089 syphilis infections were reported. Most of the cases were diagnosed in men having sex with men (MSM) and were mainly reported by STI clinics located in the Paris area. From 1997 to 2000, an increase of gonorrhea was observed each year. After two years of stable trend, the prevalence of gonorrhea increased again in 2003. From 2002 to 2004, 123 LGV cases were diagnosed in France and were observed only in MSM. Since 2001, Chlamydia infections have steadily increased, particularly in women. COMMENTS Because STI surveillance is based on a voluntary basis, the number of reported cases is probably lower than the number of STI diagnosed in France. However, the data provided by the different surveillance systems reveals that STI have been increasing in France since 1997. Moreover, the resurgence of syphilis in 2000 and the emergence of rectal LGV in 2004 indicate that these STI occur mainly in MSM. Trends on incidence and patients characteristics observed in France are similar to those of several Europeans countries. European Public Health interventions are becoming necessary to prevent and control STI.
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Affiliation(s)
- M Herida
- Institut de Veille Sanitaire, 12 rue du Val-d'Osne, 94414 Saint-Maurice, France.
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