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Lymphogranuloma venereum presenting as genital ulceration and inguinal syndrome in men who have sex with men in London, United Kingdom
  1. Gulshan Sethi
  1. Department of Genitourinary Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
    1. Erica Allason-Jones
    1. The Mortimer Market Centre, Camden Primary Care Trust, London, United Kingdom
      1. John Richens
      1. Centre for Sexual health and HIV Research, University College London, United Kingdom
        1. Naa Torshie Annan
        1. St. Stephen’s Centre, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
          1. David Hawkins
          1. St. Stephen’s Centre, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
            1. Anjali Ekbote
            1. Department of Genitourinary Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
              1. Sarah Alexander
              1. Sexually Transmitted Bacteria Reference Laboratory, Health Protection Agency, Colindale, United Kingdom
                1. John White (john.white{at}gstt.nhs.uk)
                1. Department of Genitourinary Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom

                  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 thirteen cases detected overall: five cases of urethral LGV infection with inguinal adenopathy, three cases of genital ulcer with LGV inguinal adenopathy, three cases of isolated LGV-associated inguinal buboes, one case of a solitary LGV penile ulcer and another case with a penile ulcer and bubonulus. Only six of the thirteen were HIV-positive and all tested negative for hepatitis C. The majority of cases reported few sexual contacts in the three months preceding their diagnosis.

                  Conclusions: Clinical manifestations of LGV have not been confined to proctitis in the current MSM 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 attempted from the relevant lesions.

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