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The prevalence of Lymphogranuloma venereum (LGV) infection in men who have sex with men: results of a multi-centre case finding study
  1. Helen Ward (h.ward{at}imperial.ac.uk)
  1. Imperial College London, United Kingdom
    1. sarah alexander (sarah.alexander{at}hpa.org.uk)
    1. Health Protection Agency, United Kingdom
      1. Caroline Carder (caroline.carder{at}uclh.nhs.uk)
      1. UCLH Microbiology Lab, United Kingdom
        1. Gillian Dean (gillian.dean{at}bsuh.nhs.uk)
        1. Brighton & Sussex University Hospitals Trust, United Kingdom
          1. Patrick French (patrick.french{at}camdenpct.nhs.uk)
          1. Camden Primary Care Trust, United Kingdom
            1. daniel ivens (daniel.ivens{at}royalfree.nhs.uk)
            1. Royal Free Hampstead NHS Trust, United Kingdom
              1. claire ling (claire.ling{at}royalfree.nhs.uk)
              1. ROyal Free Hospital, United Kingdom
                1. John Paul (john.paul{at}bsuh.nhs.uk)
                1. Brighton & Sussex University Hospitals Trust, United Kingdom
                  1. Cheuk Tong (william.tong{at}gstt.nhs.uk)
                  1. Guy's and St. Thomas' NHS Foundation Trust, United Kingdom
                    1. John White (john.white{at}gstt.nhs.uk)
                    1. Guy's and St. Thomas' NHS Foundation Trust, United Kingdom
                      1. Catherine A Ison (catherine.ison{at}hpa.org.uk)
                      1. Health Protection Agency, United Kingdom

                        Abstract

                        Objectives: To determine the prevalence of urethral and rectal Chlamydia trachomatis (CT) infection of lymphogranuloma venereum (LGV) and non-LGV associated serovars, in men who have sex with men (MSM).

                        Design: Multi-centre cross sectional survey.

                        Setting: Four genitourinary medicine clinics in the UK from 2006-7.

                        Subjects: 4825 urethral and 6778 rectal samples from consecutive MSM attending for sexual health screens.

                        Methods: Urethral swabs or urine and rectal swabs were tested for CT using a 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, 6.66) for non-LGV CT, and 0.90% (0.69, 1.16) for LGV; for urethral samples 3.21% (2.74, 3.76) for non-LGV CT and 0.04% (0.01, 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.

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