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Letter
LGV Chlamydia trachomatis serotypes: an update from Milan, Italy
  1. Susanna Benardon1,
  2. Giovanna Lunghi1,
  3. Patrizia Bono1,
  4. Annarosa Orlandi1,
  5. Francesca Pacela1,
  6. Antonella Zoccoli1,
  7. Enzo Boeri2,
  8. Michela Sampaolo2,
  9. Marco Cusini1
  1. 1 Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
  2. 2 San Raffaele Hospital, Milan, Italy
  1. Correspondence to Dr Marco Cusini, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Pace 9, Milan 20122, Italy; m.cusini{at}policlinico.mi.it

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Up until 2003, a few cases of Lymphogranuloma venereum (LGV) diagnosed in Europe were known to be caused by L serovars of Chlamydia trachomatis (L1, L2a, L3). However, the current epidemic, which began among European men who have sex with men (MSM) in 2003, has seen the emergence of LGV with novel epidemiological and clinical features (most notably, the variant L2b).

The evidence reported by this letter from our STI centre in Milan reflects the ongoing development of this situation.

Of the 22 patients who attended the centre with clinical symptoms related to LGV, 19 had proctitis and 3 had genital symptoms. The patients were exclusively MSM and had a median age of 43 years (range 29–58): 13/22 were HIV positive, 9/18 syphilis positive and 6/16 HCV antibody positive. Samples were processed using a purpose-designed method1 which targeted the codifying gene for polymorphic membrane protein (pmpH gene) in order to identify the presence of L1–L3 C. trachomatis serovars. In response to recent reports of new variants and the co-circulation of variants, LGV-positive samples were genotyped by nested OP1 PCR and sequenced2 with Applied Biosystems 2720 Thermal Cycler. The consensus sequences were compared with known C. trachomatis LGV strains by using the BLAST search tool (http://www.ncbi.nim.nih.gov).

Among the 22 cases, 18 were attributable to serovar L2b, 1 to serovar L2c, 2 to serovar D and 1 to serovar G. This last case was initially proved negative by PCR real-time method, based on the pmpH gene amplification, but underwent genotyping nevertheless because the patient presented with typical LGV symptomatology (mucus blood anal secretion and rectal pain). The patients with serovar D were diagnosed last year.

Our data show that the L2b variant, which is implicated in the worldwide LGV outbreak, is still the prevalent agent of the LGV outbreak in Milan (94%). But it also highlights the emergence of other genotypes. Recombination events between L and D serovars facilitating the selection of new recombinant variants could in future contribute significantly to the progress of the epidemic.

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Footnotes

  • Competing interests None declared.

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