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Risk factors for rectal lymphogranuloma venereum in gay men: results of a multicentre case-control study in the UK
  1. N Macdonald1,
  2. A K Sullivan2,
  3. P French3,
  4. J A White4,
  5. G Dean5,
  6. A Smith6,
  7. A J Winter7,
  8. S Alexander8,
  9. C Ison8,
  10. H Ward1
  1. 1Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
  2. 2Chelsea and Westminster NHS Foundation Trust, London, UK
  3. 3Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
  4. 4Guy's and St Thomas’ NHS Foundation Trust, London, UK
  5. 5Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
  6. 6Jefferiss Wing Centre for Sexual Health, Imperial College Healthcare NHS Trust, London, UK
  7. 7Sandyford Sexual Health Services, Glasgow, UK
  8. 8Sexually Transmitted Bacterial Reference Unit, Public Health England, London, UK
  1. Correspondence to
    Neil Macdonald, Infectious Disease Epidemiology, Imperial College, Imperial College Faculty of Medicine, Norfolk Place, London W2 1PG, UK; n.macdonald{at}imperial.ac.uk

Abstract

Objective To identify risk factors for rectal lymphogranuloma venereum (rLGV) in men who have sex with men (MSM).

Design A case-control study at 6 UK hospitals compared MSM with rLGV (cases) with rLGV-negative controls: MSM without potential rLGV symptoms (CGa) and separately, MSM with such symptoms (CGs).

Methods Between 2008 and 2010, there were 90 rLGV cases, 74 CGa and 69 CGs recruited. Lifestyles and sexual behaviours in the previous 3 months were reported using internet-based computer-assisted self-interviews. Logistic regression was used to investigate factors associated with rLGV.

Results Cases were significantly more likely to be HIV-positive (89%) compared with CGa (46%) and CGs (64%). Independent behavioural risks for rLGV were: unprotected receptive anal intercourse (adjusted OR (AOR)10.7, 95% CI 3.5 to 32.8), fisting another (AOR=6.7, CI 1.8 to 25.3), sex under the influence of gamma-hydroxybutyrate (AOR=3.1, CI 1.3 to 7.4) and anonymous sexual contacts (AOR=2.7, CI 1.2 to 6.3), compared with CGa; unprotected insertive anal intercourse (AOR=4.7, CI 2.0 to 10.9) and rectal douching (AOR=2.9 CI 1.3 to 6.6), compared with CGs. An incubation period from exposure to symptoms of 30 days was indicated.

Conclusions Unprotected receptive anal intercourse is a key risk factor for rectal LGV with the likelihood that rectal-to-rectal transmission is facilitated where insertive anal sex also occurs. The association between HIV and rLGV appears linked to HIV-positive men seeking unprotected sex with others with the same HIV status, sexual and drug interests. Such men should be targeted for frequent STI screening and interventions to minimise associated risks.

  • Chlamydia Trachomatis
  • Lymphogranuloma Venereum
  • Gay Men
  • Sexual Behaviour
  • HIV

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