Prevalence and predictors of lymphogranuloma venereum among men who have sex with men at a Sydney metropolitan sexual health clinic

During an 18-month period to June 2012, 1732 anal chlamydia (Chlamydia trachomatis) tests were performed among men who have sex with men (MSM) at RPA Sexual Health in Sydney’s inner west. Positive anal chlamydia samples were subsequently tested for lymphogranuloma venereum (LGV). Seventy-five (4.3%) anal samples were positive for chlamydia among 67 men during the study period. Anal symptoms were reported for 16 out of 75 (21.3%) of anal chlamydia episodes overall. Three episodes of LGV (all serovar L2b) were identified, all three of whom reported anal symptoms (100%, 95% confidence interval (CI): 29.2–100%). In contrast, only 13/72 (18.1%, 95% CI: 10.0–28.9%) of those with non-LGV anal chlamydia reported anal symptoms. LGV was not identified in any of 59 episodes of asymptomatic anal chlamydia (0%, 95% CI: 0–6.1%). Of those with LGV, two were known to be HIV-positive and one subsequently seroconverted to HIV within a year of the LGV diagnosis. Our findings suggest that routine LGV testing among MSM is not warranted, except among those with anal symptoms.

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Lymphogranuloma venereum genovariants in men having sex with men in Italy

Sexually Transmitted Infections ◽

10.1136/sextrans-2020-054700 ◽

2020 ◽

pp. sextrans-2020-054700

Author(s):

Antonella Marangoni ◽

Claudio Foschi ◽

Federico Tartari ◽

Valeria Gaspari ◽

Maria Carla Re

Keyword(s):

Chlamydia Trachomatis ◽

Lymphogranuloma Venereum ◽

Hiv Positive ◽

Nucleotide Polymorphisms ◽

Single Nucleotide ◽

High Burden ◽

Total Prevalence ◽

Sex With Men ◽

Reference Strains ◽

Over Time

ObjectivesLymphogranuloma venereum (LGV) is an STI caused by Chlamydia trachomatis serovars L1-L3. In Europe, the current epidemic is caused mainly by L2b genovariant, although increasing cases associated with other L2 variants have been reported. Here, we assessed the distribution of rectal LGV genovariants among men having sex with men (MSM) in Italy.MethodsFrom 2016 to 2020, all the anorectal swabs collected from MSM attending the STI Clinic of St. Orsola-Malpighi Hospital in Bologna and positive for C. trachomatis were stored. LGV infection was confirmed by a pmpH PCR, and, subsequently, a fragment of the ompA gene was amplified and sequenced. Sequences were aligned to reference strains representing different LGV variants.ResultsLGV cases accounted for one-third of all chlamydial rectal infections with a total prevalence of 4.1% (76/1852). Total number of LGV cases per year remained constant. LGV was mainly found in symptomatic patients (>65%), older than 30 years, with a high burden of other STIs (63.7% HIV-positive, 35.5% with concurrent rectal gonorrhoea, 19.7% with early syphilis). A decreasing trend in HIV-LGV co-infection was noticed over time. Three main LGV genovariants were detected (L2f, 46.1%; L2b, 23.0%; L2-L2b/D-Da, 16.9%), together with other known L2b variants (mainly L2bV2 and L2bV4). Two novel L2b ompA variants with non-synonymous single-nucleotide polymorphisms were found. Over time, the percentage of L2f cases dropped gradually, with a significant increase in L2-L2b/D-Da cases (p=0.04).ConclusionsIn our area, LGV is endemic among MSM with different circulating genovariants. Active surveillance and genotyping programmes are needed to reduce re-establishing of LGV infection.

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Outbreak of lymphogranuloma venereum among men who have sex with men in Barcelona 2007/08 – an opportunity to debate sexual health at the EuroGames 2008

Eurosurveillance ◽

10.2807/ese.13.25.18908-en ◽

2008 ◽

Vol 13 (25) ◽

Author(s):

M Vall Mayans ◽

E Caballero ◽

P Garcia de Olalla ◽

P Armengol ◽

MG Codina ◽

...

Keyword(s):

Chlamydia Trachomatis ◽

Sexual Health ◽

Sexually Transmitted Infection ◽

Western Europe ◽

Lymphogranuloma Venereum ◽

Transmitted Infection ◽

Sexually Transmitted ◽

First Case ◽

Sex With Men

Lymphogranuloma venereum (LGV) is a systemic sexually transmitted infection (STI) caused by Chlamydia trachomatis (L serovars L1, L2 or L3). Since 2003, several outbreaks of rectal LGV affecting men who have sex with men (MSM) have occurred in western Europe [1]. The first case in Spain was confirmed in Barcelona in 2005 [2], but no further cases have been detected in this city since until September 2007. We briefly summarise the characteristics of the LGV cases diagnosed at the outpatient STI clinic in Barcelona between September 2007 and April 2008.

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Increasing yield of pharyngeal Chlamydia trachomatis among male gay and bisexual clinic attendees in Sydney: an observational study

Sexual Health ◽

10.1071/sh16181 ◽

2017 ◽

Vol 14 (3) ◽

pp. 282 ◽

Cited By ~ 3

Author(s):

Sian Louise Goddard ◽

Preethi Rajagopal ◽

David James Templeton

Keyword(s):

Chlamydia Trachomatis ◽

Observational Study ◽

Confidence Interval ◽

Sexual Health ◽

Odds Ratio ◽

Temporal Trends ◽

Health Clinic ◽

And Bisexual ◽

Ongoing Surveillance ◽

Anogenital Infection

Background The aim of the present study was to describe the temporal trends in Chlamydia trachomatis (CT) testing yield among gay and bisexual male (GBM) sexual health clinic attendees in Sydney. Methods: All CT testing occasions among GBM from January 2011 to December 2014 were reviewed. Yield was defined as the proportion of testing occasions where CT was detected. Results: In all, 2917 GBM were tested on 5445 occasions. CT was detected on 439 (8.1%; 95% confidence interval (CI) 7.4–8.8%) occasions. Pharyngeal, urethral and anorectal CT were detected on 74 (1.4%; 95% CI 1.1–1.7%), 109 (2.0%; 95% CI 1.7–2.4%) and 333 (6.1%; 95% CI 5.5–6.8%) occasions respectively. Over the study period, there was a significant increase in pharyngeal CT yield (from 0.70% to 1.6%; odds ratio (OR) 1.25; 95% CI 1.01–1.55; Ptrend = 0.043), which remained borderline significant (OR 1.22; 95% CI 0.99–1.52; P = 0.067) when adjusted for age. There was no change in yield of either urethral or anorectal infections. Almost half the pharyngeal CT (n = 35; 47.3%) occurred without concurrent anogenital infection. Excluding those who would have received anti-chlamydial treatment for another reason, 27.0% of pharyngeal and 4.6% of all CT infections would not have been treated without pharyngeal testing. Conclusions: A recent temporal increase was observed in the yield of pharyngeal CT without a concurrent increase in anogenital yield. Ongoing surveillance is warranted to inform testing guidelines for GBM.

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Prevalence and predictors of chlamydia co-infection among patients infected with gonorrhoea at a sexual health clinic in Sydney

Sexual Health ◽

10.1071/sh11146 ◽

2012 ◽

Vol 9 (4) ◽

pp. 392 ◽

Cited By ~ 5

Author(s):

David J. Templeton ◽

Niveditha Manokaran ◽

Catherine C. O'Connor

Keyword(s):

Chlamydia Trachomatis ◽

Confidence Interval ◽

Neisseria Gonorrhoeae ◽

Sexual Health ◽

Medical Records ◽

Clinic Visit ◽

Health Clinic ◽

Gram Stain ◽

Health Clinics ◽

Sexual Health Clinics

Anogenital gonorrhoea (Neisseria gonorrhoeae) is commonly diagnosed at sexual health clinics by on-site microscopy. Whether to add anti-chlamydial therapy in such situations is unclear. The medical records of all patients diagnosed with gonorrhoea between May 2005 and April 2010 at RPA Sexual Health were reviewed. Of 165 patients with anogenital gonorrhoea, 27 (16.4%, 95% confidence interval (CI) 11.1–22.9%) were co-infected with chlamydia (Chlamydia trachomatis). Compared with those only infected with anogenital gonorrhoea, there was no correlation of anogenital gonorrhoea–chlamydia co-infection with any demographic, behavioural or clinical variables examined. Anti-chlamydial therapy should be considered for all patients with gram stain diagnosed anogenital gonorrhoea at the initial clinic visit.

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Bacterial Load of Chlamydia trachomatis in the Posterior Oropharynx, Tonsillar Fossae, and Saliva among Men Who Have Sex with Men with Untreated Oropharyngeal Chlamydia

Journal of Clinical Microbiology ◽

10.1128/jcm.01375-19 ◽

2019 ◽

Vol 58 (1) ◽

Cited By ~ 6

Author(s):

Tiffany R. Phillips ◽

Christopher K. Fairley ◽

Kate Maddaford ◽

Jennifer Danielewski ◽

Jane S. Hocking ◽

...

Keyword(s):

Chlamydia Trachomatis ◽

Confidence Interval ◽

Sexual Health ◽

Bacterial Load ◽

Saliva Sample ◽

Health Centre ◽

Anatomical Site ◽

Content Type ◽

Significant Difference ◽

Sex With Men

ABSTRACT The aim of this study was to determine whether Chlamydia trachomatis could be detected in saliva and if infection is specific to an anatomical site in the oropharynx. Men who have sex with men (MSM) who were diagnosed with oropharyngeal chlamydia at the Melbourne Sexual Health Centre in 2017-2018 were invited to participate upon returning for treatment. Swabs at the tonsillar fossae and posterior oropharynx and a saliva sample were collected. Throat samples were tested for C. trachomatis by the Aptima Combo 2 assay. The bacterial loads of C. trachomatis in all samples were assessed by quantitative PCR (qPCR) detecting the ompA gene. We calculated the positivity and bacterial load of C. trachomatis for all samples. Forty-two MSM were included. The median age was 28 years (interquartile range [IQR], 24 to 33 years). Thirty-two participants (76.2%; 95% confidence interval [CI], 60.5% to 87.9%) had C. trachomatis detected by qPCR at both the tonsillar fossae and the posterior oropharynx, followed by 9.5% (n = 4; 95% CI, 2.7% to 22.6%) positive at the posterior oropharynx only and 4.8% (n = 2; 95% CI, 0.58% to 16.2%) positive at the tonsillar fossae only. Twenty-nine MSM had C. trachomatis detected in saliva (69.0%; 95% CI, 52.9% to 82.3%). The median C. trachomatis load in saliva was 446 copies/ml (IQR, 204 to 1,390 copies/ml), that in the tonsillar fossae was 893 copies/swab (IQR, 390 to 13,224 copies/ml), and that in the posterior oropharynx was 1,204 copies/swab (IQR, 330 to 16,211). There was no significant difference in C. trachomatis load between the tonsillar fossae and the posterior oropharynx (P = 0.119). Among MSM with oropharyngeal chlamydia, nearly three-quarters had chlamydia DNA detected in saliva, although the viability and implications for transmission are unknown.

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Detection of Neisseria gonorrhoeae and Chlamydia trachomatis from pooled rectal, pharyngeal and urine specimens in men who have sex with men

Sexually Transmitted Infections ◽

10.1136/sextrans-2017-053303 ◽

2017 ◽

Vol 94 (4) ◽

pp. 293-297 ◽

Cited By ~ 20

Author(s):

David John Speers ◽

I-Ly Joanna Chua ◽

Justin Manuel ◽

Lewis Marshall

Keyword(s):

Nucleic Acid ◽

Chlamydia Trachomatis ◽

Neisseria Gonorrhoeae ◽

Sexual Health ◽

Point Of Care ◽

Standard Of Care ◽

Urine Samples ◽

Health Clinic ◽

Sex With Men ◽

The Cost

ObjectivesScreening of men who have sex with men (MSM) for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) requires sampling from anorectal and pharyngeal sites in addition to urogenital sampling. Due to the cost of testing multiple anatomical sites individually testing of pooled specimens has potential merit. The Cepheid GeneXpert CT/NG assay (GeneXpert), which also has potential for point-of-care nucleic acid testing in the sexual health clinic, has not been assessed for pooled specimen testing.MethodsWe prospectively compared GeneXpert testing of pooled pharyngeal and rectal swabs with urine samples to standard of care testing of individual specimens from 107 participants using the Roche cobas 4800 CT/NG assay (cobas) for CT and NG in high-risk MSM attending an inner city sexual health clinic.ResultsWe found testing of pooled pharyngeal, rectal and urine samples by the GeneXpert to have 100% agreement for NG and 94% overall agreement for CT when compared with individual specimen testing by cobas. For CT testing, 14 cases were detected for both tests, 4for cobas only, 2 for GeneXpert only and 89 participants were negative for both tests.ConclusionsPooled specimen CT and NG testing by the GeneXpert was accurate when compared with single specimen testing and has potential for screening MSM for CT and NG. The role of pooled specimen testing with the GeneXpert as a point-of-care nucleic acid test in MSM requires further investigation.

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