Prevalence and predictors of Lymphogranuloma venereum in a high risk population attending a STD outpatients clinic in Italy

BMC Research Notes

Roberto Cevenini²  Maria Letizia Bacchi Reggiani³  Andrea Filippini¹  Sara Bellavista¹  Monica Compri²  Paola Nardini²  Antonietta D’Antuono¹  Antonella Marangoni²  Claudio Foschi² 

[1]Dermatology, DIMES, University of Bologna, St. Orsola Hospital, Via Massarenti, 9, 40138 Bologna, Italy

[2]Microbiology, DIMES, University of Bologna, St. Orsola Hospital, Via Massarenti, 9, 40138 Bologna, Italy

[3]Cardiology, DIMES, University of Bologna, St. Orsola Hospital, Via Massarenti, 9, 40138 Bologna, Italy

关键词: NAATs;    Chlamydia trachomatis;    MSM;    LGV;   

Others  :  1133928
DOI  :  10.1186/1756-0500-7-225

 received in 2014-01-28, accepted in 2014-04-04,  发布年份 2014

【 摘 要 】

Background

We evaluated LGV prevalence and predictors in a high risk population attending a STI Outpatients Clinic in the North of Italy.

Methods

A total of 108 patients (99 MSM and 9 women), with a history of unsafe anal sexual intercourses, were enrolled. Anorectal swabs and urine samples were tested for Chlamydia trachomatis (CT) DNA detection by Versant CT/GC DNA 1.0 Assay (Siemens Healthcare Diagnostics Terrytown, USA). RFLP analysis was used for CT molecular typing.

Results

L2 CT genotype was identified in 13/108 (12%) rectal swabs. All LGV cases were from MSM, declaring high-risk sexual behaviour and complaining anorectal symptoms. Patients first attending the STI Outpatient Clinic received a significant earlier LGV diagnosis than those first seeking care from general practitioners or gastroenterologists (P = 0.0046).

LGV prevalence and characteristics found in our population are in agreement with international reports. Statistical analysis showed that LGV positive patients were older (P = 0.0008) and presented more STIs (P = 0.0023) than LGV negative ones, in particular due to syphilis (P < 0.001), HIV (P < 0.001) and HBV (P = 0.001).

Multivariate logistic regression analysis revealed that HIV and syphilis infections are strong risk factors for LGV presence (respectively, P = 0.001 and P = 0.010).

Conclusions

Even if our results do not provide sufficient evidence to recommend routine screening of anorectal swabs in high-risk population, they strongly suggest to perform CT NAAT tests and genotyping on rectal specimens in presence of ulcerative proctitis in HIV and/or syphilis-positive MSM. In this context, CT DNA detection by Versant CT/GC DNA 1.0 Assay, followed by RFLP analysis for molecular typing demonstrated to be an excellent diagnostic algorithm for LGV identification.

【 授权许可】

   
2014 Foschi et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Stary G, Meyer T, Bangert C, Kohrgruber N, Gmeinhart B, Kirnbauer R, Jantschitsch C, Rieger A, Stary A, Geusau A: New chlamydia trachomatis L2 strains identified in a recent outbreak of lymphogranuloma venereum in Vienna, Austria. Sex Transm Dis 2008, 35:377-382.
• [2]Nieuwenhuis RF, Osserwaarde JM, Götz HM, Dees J, Thio HB, Thomeer HG, den Hollander JC, Neumann MH, van der Meijden WI: Resurgence of lymphogranuloma venereum in Western Europe: an outbreak of chlamydia trachomatis serovar L2 proctitis in The Netherlands among men who have sex with men. Clin Infect Dis 2004, 39(Suppl 7):996-1003.
• [3]Cusini M, Boneschi V, Arancio L, Ramoni S, Venegoni L, Gaiani F, de Vries HJ: Lymphogranuloma venereum: the Italian experience. Sex Transm Infect 2009, 85(Suppl 3):171-172.
• [4]Kerndt PR, Ferrero DV, Aynalem G, Monga D, Wang S, Zhang N, Wong C, Liggins M, Meng Q: First report of performance of the versant CT/GC DANN 1.0 assay (kPCR) for detection of Chlamydia trachomatis and Neisseria gonorrhoeae. J Clin Microbiol 2011, 49(Suppl 4):1347-1353.
• [5]Lan J, Ossewaarde JM, Walboomers JM, Meijer CJ, van den Brule AJ: Improved PCR sensitivity for direct genotyping of Chlamydia trachomatis serovars by using a nested PCR. J Clin Microbiol 1994, 32(Suppl 2):528-530.
• [6]Gallo Vaulet L, Entrocassi C, Corominas AI, Rodriguez Fermepin M: Distribution study of Chlamydia trachomatis genotypes in symptomatic patients in Buenos Aires, Argentina: association between genotype E and neonatal conjunctivitis. BMC Res Notes 2010, 3:34. BioMed Central Full Text
• [7]Sayada C, Denamur E, Orfila J, Catalan F, Elion J: Rapid genotyping of the Chlamydia trachomatis major outer membrane protein by the polymerase chain reaction. FEMS Microbiol Lett 1991, 67(Suppl 1):73-78.
• [8]Whiley DM, Buda PJ, Bayliss J, Cover L, Bates J, Sloots TP: A new confirmatory Neisseria gonorrhoeae real-time PCR assay targeting the porA pseudogene. Eur J Clin Microbiol Infect Dis 2004, 23(Suppl 9):705-710.
• [9]Ward H, Alexander S, Carder C, Dean G, French P, Ivens D, Ling C, Paul J, Tong W, White J, Ison CA: The prevalence of lymphogranuloma venereum infection in men who have sex with men: results of a multicentre case finding study. Sex Transm Infect 2009, 85(Suppl 3):173-175.
• [10]Defraye A, Van Beckhoven D, Sasse A: Surveillance of sexually transmitted infections among persons living with HIV. Int J Public Health 2011, 56(Suppl 2):169-174.
• [11]Martin-Iguacel R, Libre JM, Nielsen H, Heras E, Matas L, Lugo R, Clotet B, Sirera G: Lymphogranuloma venereum proctocolitis: a silent disease in men who have sex with men in industrialized countries. Eur J Clin Microbiol Infect Dis 2010, 29:917-925.
• [12]Hoentjen F, Rubin DT: Infectious proctitis: when to suspect it is not inflammatory bowel disease. Dig Dis Sci 2012, 57(Suppl 2):269-273.
• [13]van der Laar MJ, Fenton KA, Ison C: Update on the European lymphogranuloma venereum epidemic among men who have sex with men. Euro Surveill 2005., 10(Suppl 6) E050602
• [14]White JA: Manifestations and management of lymphogranuloma venereum. Curr Opin Infect Dis 2009, 22(Suppl 1):57-66.
• [15]European Centre for Disease Prevention and Control: Sexually transmitted infections in Europe 2011. Stockholm, Sweden: ECDC; 2013.
• [16]de Vrieze NH, van Rooijen M, Speksnijder AG, de Vries HJ: Urethral lymphogranuloma venereum infections in men with anorectal lymphogranuloma venereum and their partners: the missing link in the current epidemic. Sex Transm Dis 2013, 40(Suppl 8):607-608.
• [17]Gallegos M, Bradly D, Jakate S, Keshavarzian A: Lymphogranuloma venereum proctosigmoiditis is a mimicker of inflammatory bowel disease. World J Gastroenterol 2012, 18(Suppl 25):3317-3321.
• [18]Van der Bij AK, Spaargaren J, Morré SA, Fennema HS, Mindel A, Coutinho RA, de Vries HJ: Diagnostic and clinical implications of anorectal lymphogranuloma venereum in men who have sex with men: a retrospective case–control study. Clin Infect Dis 2006, 42:186-194.
• [19]Ward H, Martin I, Macdonald N, Alexander S, Simms I, Fenton K, French P, Dean G, Ison C: Lymphogranuloma venereum in the United Kingdom. Clin Infect Dis 2007, 44(Suppl 1):26-32.
• [20]Rönn MM, Ward H: The association between Lymphogranuloma venereum and HIV among men who have sex with men: systematic review and meta-analysis. BMC Infect Dis 2011, 11:70. BioMed Central Full Text
• [21]van Nieuwkoop C, Gooskens J, Smit VT, Claas EC, van Hogezand RA, Kroes AC, Kroon FP: Lymphogranuloma venereum proctocolitis: mucosal T cell immunity of the rectum associated with chlamydial clearance and clinical recovery. Gut 2007, 56(Suppl 10):1476-1477.
• [22]By P, Papp JR, Schachter J, Gaydos CA, Van Der Pol B: Recommendations for the Laboratory-Based Detection of Chlamydia trachomatis and Neisseria gonorrhoeae - 2014. MMWR Recomm Rep 2014, 63(RR-02):1-19.
• [23]Workowski KA, Berman S: Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep 2010, 59(RR-12):1-110.
• [24]de Vries HJC, Morré SA, White JA, Moi H: European guideline of the management of lymphogranuloma venereum, 2010. Int J STD AIDS 2010, 21(Suppl 8):533-536.