Objectives Recent outbreaks of anorectal lymphogranuloma venereum (LGV) among men who have sex with men (MSM) have been characterised by proctocolitis requiring extended antibiotic treatment compared with infections caused by other serovars of Chlamydia trachomatis (CT). We describe the prevalence and clinical features of LGV among Nigerian MSM diagnosed with anorectal CT.
Methods MSM were recruited for this observational cohort in Lagos, Nigeria, using respondent-driven sampling and screened for HIV and bacterial STIs every three months for up to 18 months. Nucleic acid amplification tests for CT were performed on rectal swab specimens. Prevalent and incident cases of anorectal CT underwent additional testing to identify LGV using novel real-time PCR assays specific for the L-serovars of CT.
Results From April 2014 to July 2016, 420 MSM underwent testing for rectal STIs, of whom 66 (15.7%) had prevalent anorectal CT. Among those without prevalent disease, 68 developed incident infections during 208 person-years of follow-up. Of 134 prevalent and incident cases of anorectal CT, 7 (5.2%) were identified as LGV. None of the seven participants with LGV reported any symptoms. Two of the participants with LGV were simultaneously coinfected with rectal gonorrhoea. HIV coinfection was common among participants with both LGV (n=5, 71%) and non-LGV (n=98, 77%) serovars of CT (P=0.66).
Conclusions Anorectal LGV was uncommon but present among Nigerian MSM in this study. Consistent screening for L-serovars of CT, or presumptive treatment for LGV in cases with a high suspicion for this diagnosis, could potentially improve patient outcomes and decrease transmission.
- chlamydia trachomatis
- lymphogranuloma venereum
- sexually transmitted infection
- men who have sex with men
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Handling editor Jackie A Cassell
Contributors TAC conceptualised these analyses, coordinated data collection and authored the first draft of the manuscript. JH performed LGV testing and assisted in the interpretation of results. KL, SO and AI coordinated and conducted other laboratory testing. ZP, AK, SeA and SyA oversaw the collection of clinical data. SDB, RGN, MEC and JA conceptualised the TRUST/RV368 study and assisted in the interpretation of results from these analyses. CAG oversaw development of the LGV assay and provided general oversight of these analyses. All authors reviewed this manuscript, provided feedback and approved the manuscript in its final form.
Funding This work was supported by a cooperative agreement between the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., and the U.S. Department of Defense (W81XWH-11-2-0174); the National Institutes of Health (R01 MH099001, R01 AI120913); Fogarty AITRP (D43TW01041); and the President’s Emergency Plan for AIDS Relief through a cooperative agreement between the Department of Health and Human Services/Centers for Disease Control and Prevention, Global AIDS Program and the Institute for Human Virology, Nigeria (U2G IPS000651).
Disclaimer The views expressed are those of the authors and should not be construed to represent the positions of the U.S. Army, the Department of Defense or the Department of Health and Human Services.
Competing interests TAC has received a speaker fee from Gilead Sciences. CAG has served as a consultant for BioFire and has received speaker fees from Cepheid and Becton Dickinson.
Patient consent Obtained.
Ethics approval This study was reviewed and approved by institutional review boards at the Walter Reed Army Institute of Research, Silver Spring, Maryland, USA; the University of Maryland, Baltimore, Maryland, USA; and the National HealthResearch Ethics Committee and Ministry of Defence, Abuja, Nigeria (approval #FHREC/2012/08//22/09-08-12). The investigators have adhered to the policies for protection of human subjects as prescribed in AR-70.
Provenance and peer review Not commissioned; externally peer reviewed.
Collaborators The TRUST/RV368 Study Group includes Principal Investigators: William Blattner and Manhattan E Charurat (IHV, University of Maryland, Baltimore, MD, USA); Co-Investigators: Alash’le Abimiku, Sylvia Adebajo, Julie Ake, Akindiran Akintunde, Senate Amusu, Stefan D Baral, Trevor A Crowell, Charlotte A Gaydos, Hongjie Liu, Jennifer Malia, Nelson Michael, Helen Omuh, Ifeanyi Orazulike, Sheila Peel, Merlin Robb, Cristina Rodriguez-Hart, Sheree Schwartz; Institutions: Institute of Human Virology at the University of Maryland School of Medicine (IHV-UMB), Johns Hopkins Bloomberg School of Public Health (JHSPH), Walter Reed Army Institute of Research (WRAIR), U.S. Military HIV Research Program (MHRP), Department of Defense (DoD), Walter Reed Program - Nigeria (WRP-N), Institute of Human Virology Nigeria (IHVN), International Centre for Advocacy for the Right to Health (ICARH), The Initiative for Equal Rights (TIERS), Population Council (Pop Council).
Presented at This work was presented, in part, at IDWeek 2017 in San Diego, California, on 4–8 October 2017.