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Original article
Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case–control study in the UK
  1. S N S Pallawela1,
  2. A K Sullivan1,
  3. N Macdonald2,
  4. P French3,
  5. J White4,
  6. G Dean5,
  7. A Smith6,
  8. A J Winter7,
  9. S Mandalia2,
  10. S Alexander8,
  11. C Ison8,
  12. H Ward2
  1. 1Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
  2. 2Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, 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, Claude Nicol Centre, 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 Laboratory, Public Health England, London, UK
  1. Correspondence to Professor Helen Ward, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College, Norfolk Place, London W2 1PG, UK; h.ward{at}imperial.ac.uk.

Abstract

Objective Since 2003, over 2000 cases of lymphogranuloma venereum (LGV) have been diagnosed in the UK in men who have sex with men (MSM). Most cases present with proctitis, but there are limited data on how to differentiate clinically between LGV and other pathology. We analysed the clinical presentations of rectal LGV in MSM to identify clinical characteristics predictive of LGV proctitis and produced a clinical prediction model.

Design A prospective multicentre case–control study was conducted at six UK hospitals from 2008 to 2010. Cases of rectal LGV were compared with controls with rectal symptoms but without LGV.

Methods Data from 98 LGV cases and 81 controls were collected from patients and clinicians using computer-assisted self-interviews and clinical report forms. Univariate and multivariate logistic regression was used to compare symptoms and signs. Clinical prediction models for LGV were compared using receiver operating curves.

Results Tenesmus, constipation, anal discharge and weight loss were significantly more common in cases than controls. In multivariate analysis, tenesmus and constipation alone were suggestive of LGV (OR 2.98, 95% CI 0.99 to 8.98 and 2.87, 95% CI 1.01 to 8.15, respectively) and that tenesmus alone or in combination with constipation was a significant predictor of LGV (OR 6.97, 95% CI 2.71 to 17.92). The best clinical prediction was having one or more of tenesmus, constipation and exudate on proctoscopy, with a sensitivity of 77% and specificity of 65%.

Conclusions This study indicates that tenesmus alone or in combination with constipation makes a diagnosis of LGV in MSM presenting with rectal symptoms more likely.

Keywords
  • LYMPHOGRANULOMA VENEREUM
  • MSM
  • PROCTITIS
  • SEXUALLY TRANSMITTED INFECTION
  • CLINICAL PREDICTORS

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 3.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/3.0/

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