The prevalence of lymphogranuloma venereum infection in men who have sex with men: results of a multicentre case finding study
- H Ward1,
- S Alexander2,
- C Carder3,
- G Dean4,
- P French5,
- D Ivens6,
- C Ling6,
- J Paul4,
- W Tong7,
- J White7,
- C A Ison2
- 1Imperial College London, London, UK
- 2Health Protection Agency Centre for Infections, UK
- 3Clinical Microbiology Department, University College London Hospitals NHS Foundation Trust, London, UK
- 4Brighton and Sussex University Hospitals, London, UK
- 5Mortimer Market Centre, Camden Primary Care Trust, London, UK
- 6Royal Free NHS Trust, London, UK
- 7Guys and St Thomas’s NHS Trust, London, UK
- Dr Helen Ward, Infectious Disease Epidemiology, Norfolk Place, London W2 1PG, UK; h.ward{at}imperial.ac.uk
- Accepted 23 January 2009
- Published Online First 15 February 2009
Abstract
Objective: To determine the prevalence of lymphogranuloma venereum (LGV) and non-LGV associated serovars of urethral and rectal Chlamydia trachomatis (CT) infection in men who have sex with men (MSM).
Design: Multicentre cross-sectional survey.
Setting: Four genitourinary medicine clinics in the United Kingdom from 2006–7.
Subjects: 4825 urethral and 6778 rectal samples from consecutive MSM attending for sexual health screening.
Methods: Urethral swabs or urine and rectal swabs were tested for CT using standard nucleic acid amplification tests. Chlamydia-positive specimens were sent to the reference laboratory for serovar determination.
Main outcome: Positivity for both LGV and non-LGV associated CT serovars; proportion of cases that were symptomatic.
Results: The positivity (with 95% confidence intervals) in rectal samples was 6.06% (5.51% to 6.66%) for non-LGV CT and 0.90% (0.69% to 1.16%) for LGV; for urethral samples 3.21% (2.74% to 3.76%) for non-LGV CT and 0.04% (0.01% to 0.16%) for LGV. The majority of LGV was symptomatic (95% of rectal, one of two urethral cases); non-LGV chlamydia was mostly symptomatic in the urethra (68%) but not in the rectum (16%).
Conclusions: Chlamydial infections are common in MSM attending for sexual health screening, and the majority are non-LGV associated serovars. We did not identify a large reservoir of asymptomatic LGV in the rectum or urethra. Testing for chlamydia from the rectum and urethra should be included for MSM requesting a sexual health screen, but serovar-typing is not indicated in the absence of symptoms. We have yet to identify the source of most cases of LGV in the UK.
Footnotes
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See Editorial, p 157
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Funding: This work was funded through the Health Protection Agency and local NHS trusts as part of the investigation of the outbreak of LGV.
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Competing interests: HW is editor of the journal, Sexually Transmitted Infections. All other authors declare no conflicts of interest.
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Presentation: Some of these data were presented at the 17th International Society for Sexually Transmitted Disease Research (ISSTDR) conference in Seattle, Washington, USA, on 29 July–1 August 2007.
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Contributors: HW, SA, PF, JW and CAI conceived of and planned the study; SA and CAI oversaw testing at the STBRL; CC, CL, JP and WT oversaw testing and processing of specimens in local laboratories; GD, PF, DI and JW oversaw the clinical investigation and retrieved patient data; HW produced the initial draft of the manuscript; all authors revised and approved the manuscript.
