Background Lymphogranuloma venereum (LGV) is a systemic sexually transmitted infection caused by Chlamydia trachomatis (CT)serovars L1-L3. In the recent outbreaks the classic clinical presentation with inguinal syndrome is giving way to anorectal primitive syndrome in men having sex with men (MSM). Here we report about 6 cases of LGV identified during 2012.

Methods A prospective study was performed with 78 rectal specimens obtained from MSM attending the STD Outpatients Clinic of S. Orsola Hospital, Bologna. All the patients were enrolled because having unsafe receptive anal sex intercourses. Samples were tested by Versant CT/GC DNA 1.0 (Siemens). Genotyping was performed with RFLP method for ompl gene, using AluI and DdeI as restriction enzymes.

Results We found a total of 11 rectal swabs positive for CT. RFLP analysis showed 6 L2 genotypes and 5 non-LGV genotypes (3 were E, and the others H and J).

The five non-LGV infected patients showed no symptoms. On the contrary, at the enrollment perianal ulcers, proctitis and painful lymphadenopathy were found in three LGV cases, whereas perianal ulcers and proctitis in the remaining three ones.

Before the correct diagnosis the patients had been investigated for several months for a broad range of other conditions, including traumatic warts, and/or gastroenteric syndromes. Three patients had undergone endoscopic procedures and ultrasound scans.

All the LGV cases presented at least one more sexually transmitted infection. Treatment with doxycycline (100 mg b.i.d. for 21 days) was successful. At control, case 1 had a positive result for Neisseria gonorrhoeae in his rectal swab, thus demonstrating his high risk sexual behaviour.

Conclusion A firm diagnosis and early treatment of LGV can prevent the development of serious sequelae. Since the ulcerative nature of LGV may facilitate transmission and acquisition of other STDs, enhanced surveillance systems and strengthened case ascertainment would be desirable.