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Universal lymphogranuloma venereum (LGV) testing of rectal chlamydia in men who have sex with men and detection of asymptomatic LGV
  1. Yasmin Hughes1,
  2. Marcus Y Chen1,2,
  3. Christopher K Fairley1,2,
  4. Jane S Hocking3,
  5. Deborah Williamson4,5,6,
  6. Jason J Ong1,2,
  7. Vesna De Petra6,
  8. Eric P F Chow1,2,3
  1. 1 Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
  2. 2 Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
  3. 3 Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
  4. 4 Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
  5. 5 Department of Microbiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
  6. 6 Microbiological Diagnostic Unit Public Health Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
  1. Correspondence to Dr Yasmin Hughes, Melbourne Sexual Health Centre, Carlton, Victoria, Australia; yasminhughes83{at}


Background Lymphogranuloma venereum (LGV) is caused by Chlamydia trachomatis serovars L1-L3. This study determined the positivity for LGV testing before and after introduction of universal LGV testing of positive rectal Chlamydia trachomatis samples in men who have sex with men (MSM).

Methods From March 2015 to February 2018, MSM with rectal C. trachomatis were not routinely tested for LGV at the Melbourne Sexual Health Centre unless they had HIV or symptoms of proctitis. From February 2018, universal testing for LGV of all positive rectal C. trachomatis specimens in men over the age of 25 years, regardless of symptoms was undertaken. LGV positivity was defined as the detection of LGV-associated C. trachomatis serovars.

Results There were 3429 and 4020 MSM who tested positive for rectal chlamydia in the selective and universal LGV-testing periods, respectively. Of the total 3027 assessable specimens in both periods, 97 (3.2%; 95% CI 2.6% to 3.9%) specimens tested positive for LGV. LGV positivity in the selective testing period was higher than in the universal testing period (6.6% (33/502) vs 2.5% (64/2525), p<0.001). The proportion of LGV cases that were asymptomatic increased from 15.2% (5/33) in the selective testing period to 34.4% (22/64) in the universal testing period (p=0.045). Of the 70 symptomatic LGV cases symptoms included rectal discharge (71.4%, n=45) and rectal pain (60.0%, n=42).

Conclusion Universal LGV testing of all positive rectal chlamydia samples in MSM compared with selective testing led to the detection of asymptomatic rectal LGV, which constituted 34% of rectal LGV cases.

  • lymphogranuloma venereum
  • chalmydia trachomatis
  • rectal diseases

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information. Not applicable.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information. Not applicable.

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  • Handling editor Jonathan Ross

  • Twitter @drdebwilliamson, @EricPFChow

  • Contributors EPFC and MYC contributed to the conception of the study and oversaw the project. EPFC, MYC, YH, DW, VDP and CKF developed and designed the methodology of the study. EPFC performed the statistical analyses. YH performed the chart review of the cases and wrote the first draft of the manuscript. DW and VDP contributed to the laboratory testing methodology and interpretation. All authors were involved in data interpretation and revising the manuscript for important intellectual content and approved the final version. EPFC and YH are the authors acting as guarantor.

  • Funding EPFC, DW and JJO are each supported by an Australian National Health and Medical Research Council (NHMRC) Emerging Leadership Investigator Grant (GNT1172873 for EPFC, GNT1174555 for DW and GNT1193955 for JJO). CKF is supported by an Australian NHMRC Leadership Investigator Grant (GNT1172900). JSH is supported by an NHMRC Senior Research Fellowship (GNT1136117).

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.