Lymphogranuloma venereum among men who have sex with men. An epidemiological and clinical review

Abstract

Lymphogranuloma venereum (LGV) is a sexually transmitted infection, previously only seen in tropical regions. This changed in 2003 when the first endemically acquired LGV cases were reported in Rotterdam, the Netherlands, among predominantly HIV positive men who have sex with men (MSM). Early diagnosis is important to prevent irreversible complications and to stop further transmission in the community. In contrast to earlier reports, approximately 25% of LGV infections are asymptomatic and form an easily missed undetected reservoir. The majority of reported infections in MSM are found in the anorectal canal and not urogenital, which leaves the mode of transmission within the MSM network unclear. Given the increasing trend, the LGV endemic is clearly not under control. Therefore directed screening must be intensified.

Keywords::

• Chlamydia trachomatis
• HIV
• lymphogranuloma venereum
• male homosexuality
• men who have sex with men
• sexually transmitted infection

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The lymphogranuloma venereum (LGV) endemic among men who have sex with men (MSM) in Western society is caused by a specific biovar L2b, also known as the Amsterdam variant.

• Until now, the LGV endemic seems confined to a core group of MSM with high-risk behavior, with no spill over into the wider MSM community. L2b infections in the heterosexual population are exceedingly rare.

• The LGV endemic in Western society is ongoing and the prevalence is rising in Europe.

• The majority of LGV infections among MSM are found in the anorectal canal. Although urethral LGV infections seem more common than thought before, the transmission mode of LGV among MSM remains unclear.

• LGV is associated with a high prevalence of sexually transmitted infections, including HIV in 80% and hepatitis C in 20% of the cases.

• LGV is asymptomatic in approximately a quarter of the cases upon the first consultation. It is therefore recommended to screen all MSM who practiced receptive anal sex in the previous 6 months for anorectal Chlamydia trachomatis infection, irrespective of signs and symptoms, and if found positive, subsequent tests to exclude LGV proctitis should be performed.

• The preferred method to screen for LGV is to first identify C. trachomatis by a commercial biovar non-specific nucleic acid amplification tests. If the test result is positive, the same sample can then be used to identify LGV with an ‘in-house’ developed LGV biovar-specific nucleic acid amplification test assay.

• The first choice of treatment for anorectal LGV is doxycycline 100 mg twice daily for 21 days, as opposed to a 7-day doxycycline regimen sufficient for C. trachomatis non-LGV biovar anorectal infections.

• Apart from counseling of index patients, sexually transmitted infection screening and presumptive treatment of all sexual partners in the previous 4 weeks is required.

Notes