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Sex Transm Infect 2009;85:165-170 doi:10.1136/sti.2008.034348
  • Clinical

Lymphogranuloma venereum presenting as genital ulceration and inguinal syndrome in men who have sex with men in London, UK

  1. G Sethi1,
  2. E Allason-Jones2,
  3. J Richens3,
  4. N T Annan4,
  5. D Hawkins4,
  6. A Ekbote1,
  7. S Alexander5,
  8. J White1
  1. 1
    Department of Genitourinary Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
  2. 2
    The Mortimer Market Centre, Camden Primary Care Trust, London, UK
  3. 3
    Centre for Sexual Health and HIV Research, University College London, London, UK
  4. 4
    St Stephen’s Centre, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
  5. 5
    Sexually Transmitted Bacteria Reference Laboratory, Health Protection Agency, Colindale, UK
  1. Dr John White, Department of Genitourinary Medicine, Guy’s and St Thomas’ NHS Foundation Trust, Lambeth Palace Road, London, SE1 7EH, UK
  • Accepted 20 November 2008
  • Published Online First 9 December 2008

Abstract

Objectives: To describe a series of lymphogranuloma venereum (LGV) cases presenting as inguinal syndrome and/or genital ulceration seen among men who have sex with men (MSM) in London, UK.

Methods: Collaborative retrospective case note review. Clinicians from three London genitourinary medicine (GUM) clinics accessed by large populations of MSM within the current LGV outbreak collected clinical data from confirmed cases of LGV inguinal syndrome or genital ulcer. LGV was confirmed by the detection of LGV-specific DNA from specimens such as bubo aspirates, ulcer swabs, urethral swabs, first void urine and rectal biopsy material.

Results: There were 13 cases detected overall: 5 cases of urethral LGV infection with inguinal adenopathy, 3 cases of genital ulcer with LGV inguinal adenopathy, 3 cases of isolated LGV-associated inguinal buboes, 1 case of a solitary LGV penile ulcer and 1 case with a penile ulcer and bubonulus. Only 6 of the 13 were HIV positive and all tested negative for hepatitis C. The majority of cases reported few sexual contacts in the 3 months preceding their diagnosis.

Conclusions: Clinical manifestations of LGV in MSM have not been confined to proctitis in the current outbreak in the UK and a small but significant number of inguinogenital cases of LGV have been observed. Epidemiologically, many of the cases described seem to have occurred at the periphery of the current MSM LGV epidemic. Clinicians need to be vigilant for these less common presentations of LGV among MSM and specific diagnostic tests should be done from the relevant lesions.

Footnotes

  • See Editorial, p 157

  • Competing interests: None.

  • Patient consent: Obtained.

  • Contributors: GS and JW conceived the paper, collected data on cases seen at St Thomas’ Hospital, co-ordinated the multicentre collaboration and wrote the final draft; EA-J, JR, NTA and DH each contributed cases from their respective clinics and edited the manuscript; AE wrote the early first draft; SA was responsible for the molecular typing and verification of LGV results as well as editing the manuscript.

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