Lymphogranuloma venereum presenting as genital ulceration and inguinal syndrome in men who have sex with men in 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.