1. Substantial underdiagnosis of lymphogranuloma venereum in men who have sex with men in Europe: preliminary findings from a multicentre surveillance pilot.
- Author
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Cole MJ, Field N, Pitt R, Amato-Gauci AJ, Begovac J, French PD, Keše D, Klavs I, Zidovec Lepej S, Pöcher K, Stary A, Schalk H, Spiteri G, and Hughes G
- Subjects
- Adult, Austria epidemiology, Bacterial Outer Membrane Proteins genetics, Chlamydia Infections diagnosis, Chlamydia Infections epidemiology, Chlamydia Infections microbiology, Chlamydia trachomatis genetics, Coinfection epidemiology, Croatia epidemiology, Epidemiological Monitoring, Europe epidemiology, Gonorrhea epidemiology, HIV Infections epidemiology, Humans, Lymphogranuloma Venereum diagnosis, Lymphogranuloma Venereum microbiology, Male, Middle Aged, Pilot Projects, Proctitis microbiology, Real-Time Polymerase Chain Reaction, Rectum microbiology, Slovenia epidemiology, United Kingdom epidemiology, Lymphogranuloma Venereum epidemiology, Proctitis epidemiology, Sexual and Gender Minorities statistics & numerical data
- Abstract
Objectives: Understanding the public health impact of lymphogranuloma venereum (LGV) in Europe is hampered by inadequate diagnostics and surveillance systems in many European countries. We developed and piloted LGV surveillance in three European countries without existing systems and performed a preliminary investigation of LGV epidemiology, where little evidence currently exists., Methods: We recruited STI or dermatovenereology clinics and associated laboratories serving men who have sex with men (MSM) in Austria, Croatia and Slovenia, using the UK for comparison. We undertook centralised LGV testing of Chlamydia trachomatis (CT)-positive rectal swabs collected between October 2016 and May 2017 from MSM attending these clinics. Stored specimens from Austria (2015-2016) and Croatia (2014) were also tested. Clinical and sociodemographic data were collected using a standardised proforma. The ompA gene of LGV-positive specimens was sequenced., Results: In total, 500 specimens from CT-positive MSM were tested, and LGV positivity was 25.6% (128/500; 95% CI 22.0% to 29.6%) overall, and 47.6% (79/166; 40.1% to 55.2%) in Austria, 20.0% (3/15; 7.1% to 45.2%) in Croatia, 16.7% (1/6; 3.0% to 56.4%) in Slovenia and 14.4% (45/313; 10.9% to 18.7 %) in the UK. Proformas were completed for cases in Croatia, Slovenia and in the UK; proformas could not be completed for Austrian cases, but limited data were available from line listings. Where recorded, 83.9% (78/93) of LGV-CT cases were HIV-positive compared with 65.4% (149/228) of non-LGV-CT cases; MSM with LGV-CT were more likely to have proctitis (Austria, 91.8% vs 40.5%, p<0.001; Croatia, 100% vs 25%, p=0.04; UK, 52.4% vs 11.7%, p<0.001) than those with non-LGV-CT. Six different ompA sequences were identified, including three new variants; the L2 ompA sequence predominated (58.6%, 51/87)., Conclusions: LGV is substantially underdiagnosed in MSM across Europe. Unified efforts are needed to overcome barriers to testing, establish effective surveillance, and optimise diagnosis, treatment and prevention., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2020
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