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Lymphogranuloma venereum in North-West Italy, 2009–2014
  1. Ivano Dal Conte1,
  2. Massimiliano Mistrangelo2,
  3. Gabriella Gregori3,
  4. Chiara Pasqualini4
    1. 1 Infectious Diseases Department, STI Clinic, Amedeo di Savoia Hospital ASLTO2, Turin, Italy
    2. 2 Department of Surgical Science, University of Turin, Turin, Italy
    3. 3 Infectious Diseases Department, Microbiology and Virology Laboratory Amedeo di Savoia Hospital ASLTO2, Turin, Italy
    4. 4 Regional Centre for Infectious Diseases Surveillance (SeREMI), ASL AL, Alessandria, Italy
    1. Correspondence to Dr Ivano Dal Conte, Infectious Diseases Department, STI Clinic, Amedeo di Savoia Hospital, Corso Svizzera 164, Torino 10149, Italy; ivano.dalconte{at}aslto2.piemonte.it

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    Since 2003 several lymphogranuloma venereum (LGV) outbreaks have been reported in Europe.1 Considering that data on LGV cases in Italy are very limited,2 enhanced surveillance was set up in North-West Italy to describe the epidemiological and clinical features of LGV cases occurring in men who had sex with men (MsM) attending public sexually transmitted infection centres. Anonymised data were collected and processed by Epi Info 3.5.1. From 1 June 2009 to 31 December 2014, 2660 anal swabs were collected: 252 (9.4%) samples resulted positive for CT-DNA: of these, 37 (14, 6%) were diagnosed with LGV-L2 genotype by real-time PCR. Symptoms and signs related to long-lasting proctitis were found in 32 out of 37 (86, 5%) patients. Three more patients had a classical LGV-L2 positive genital infection. The number of cases increased from 3 in 2009, to 10 in 2014. The median age was 41.5 years (range 23–60). Eleven (27, 5%) persons reported unsafe sex while travelling in Europe (mainly Spain and Germany). The number of anonymous sexual contacts in the previous 3 months was 12 (range 1–45) and occurred in saunas (50%), cruising places (37, 5%), sex parties (30%), darkrooms (22, 5%) or by social networks (15%). Unprotected anal sex was reported by more than 80% of subjects. Concurrent HIV and other sexually transmitted infections were diagnosed in 97% and 45% of subjects, respectively. The prevalence of hepatitis C (HCV) infection recorded in this study (20%) is the highest reported in Europe so far.1

    Italian LGV cases shared many similarities with the European ones. This cluster shows the further spread to the outermost European regions of an ongoing outbreak involving MsM; therefore a shared international multistep prevention project is urgently needed. Collaboration among Public Health Authorities, patients with HIV and MsM organisations is crucial to raise awareness, implement clinical services and prevention activities.

    Acknowledgments

    The authors thank Irene Colombraro, Valeria Gumina, Vincenzina Prezioso, Chiara Suez, Tina Venezia and all the other health professionals who provided and cared for the patients in the clinical setting.

    References

    Footnotes

    • Collaborators Maria Laura Stella; Ilaria Motta.

    • Contributors IDC initiated the project, clinically managed the patients, redesigned data collection tools, monitored data, cleaned and analysed the data, drafted and revised the paper. CP designed data analysis, redesigned data collection tools, cleaned and analysed the data, drafted and critically revised the paper; MM performed literature review, clinically managed the patients and monitored data collection, drafted and revised the paper; GG performed laboratory and technical work, drafted and revised the paper.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.