Substantial underdiagnosis of lymphogranuloma venereum in men who have sex with men in Europe: Preliminary findings from a multicentre surveillance pilot

Michelle Cole*, Nigel Field, Rachel Pitt, Andrew J. Amato-Gauci, Josip Begovac, Patrick D. French, Darja Keše, Irena Klavs, Snjezana Zidovec Lepej, Katharina Pöcher, Angelika Stary, Horst Schalk, Gianfranco Spiteri, Gwenda Hughes

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)137-142
Number of pages6
JournalSexually Transmitted Infections
Volume96
Issue number2
DOIs
Publication statusPublished - 1 Mar 2020

Bibliographical note

Funding Information:
Funding The work was funded by the european centre for Disease Prevention and control (nP/2016/Ocs/5814/01).

Publisher Copyright:
© 2020 Author(s).

Keywords

  • anogenital conditions
  • lymphogranuloma venereum
  • surveillance

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