Asymptomatic lymphogranuloma venereum among Nigerian men who have sex with men

ObjectivesRecent outbreaks of anorectal lymphogranuloma venereum (LGV) among men who have sex with men (MSM) have been characterised by proctocolitis requiring extended antibiotic treatment compared with infections caused by other serovars of Chlamydia trachomatis (CT). We describe the prevalence and clinical features of LGV among Nigerian MSM diagnosed with anorectal CT.MethodsMSM were recruited for this observational cohort in Lagos, Nigeria, using respondent-driven sampling and screened for HIV and bacterial STIs every three months for up to 18 months. Nucleic acid amplification tests for CT were performed on rectal swab specimens. Prevalent and incident cases of anorectal CT underwent additional testing to identify LGV using novel real-time PCR assays specific for the L-serovars of CT.ResultsFrom April 2014 to July 2016, 420 MSM underwent testing for rectal STIs, of whom 66 (15.7%) had prevalent anorectal CT. Among those without prevalent disease, 68 developed incident infections during 208 person-years of follow-up. Of 134 prevalent and incident cases of anorectal CT, 7 (5.2%) were identified as LGV. None of the seven participants with LGV reported any symptoms. Two of the participants with LGV were simultaneously coinfected with rectal gonorrhoea. HIV coinfection was common among participants with both LGV (n=5, 71%) and non-LGV (n=98, 77%) serovars of CT (P=0.66).ConclusionsAnorectal LGV was uncommon but present among Nigerian MSM in this study. Consistent screening for L-serovars of CT, or presumptive treatment for LGV in cases with a high suspicion for this diagnosis, could potentially improve patient outcomes and decrease transmission.

Download Full-text

Asymptomatic Lymphogranuloma Venereum among Nigerian Men who have Sex with Men

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx162.166 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S69-S70

Author(s):

Trevor Crowell ◽

Justin Hardick ◽

Kara Lombardi ◽

Senate Amusu ◽

Sunday Odeyemi ◽

...

Keyword(s):

Chlamydia Trachomatis ◽

Rectal Swab ◽

Lymphogranuloma Venereum ◽

Rectal Pain ◽

Sexually Transmitted ◽

Oropharyngeal Swab ◽

Rapid Tests ◽

Sex With Men ◽

Incident Cases

Abstract Background Among men who have sex with men (MSM), lymphogranuloma venereum (LGV) has been associated with proctocolitis that can lead to chronic complications and requires a longer course of antibiotic therapy than is recommended for infections due to other serovars of Chlamydia trachomatis (CT). We describe the prevalence and clinical features of LGV among Nigerian MSM diagnosed with anorectal CT. Methods MSM were recruited into the ongoing RV368 cohort in Lagos, Nigeria, using respondent-driven sampling. Participants were screened for HIV and bacterial sexually transmitted infections (STIs) every three months for up to 18 months. HIV was diagnosed using a parallel algorithm of rapid tests on fingerstick blood samples. PCR testing for Neisseria gonorrheae and CTwas performed on voided urine, oropharyngeal swab, and rectal swab specimens. For this analysis, prevalent and incident cases of rectal CT infection underwent additional testing to identify LGV serovars utilizing novel real-time PCR assays specific for the L serovars of CT Chlamydia trachomatis. Results From 28 April 2014–19 July 2016, 420 men underwent screening for rectal STIs, including 66 (15.7%) who had prevalent rectal infection with CT. An additional 68 participants developed incident infections during 208 person-years of follow-up. Of 134 eligible rectal swab specimens, 128 underwent further testing for LGV serovars. Seven (5.5%) of the tested samples were identified as LGV serovars of CT. None of the seven participants with LGV reported any symptoms such as fever or rectal pain. Two of the participants with LGV were simultaneously co-infected with rectal gonorrhea. HIV co-infection was common among participants with both LGV and non-LGV serovars of CT (71% and 77%, respectively, P = 0.74). Conclusion LGV was uncommon but present among Nigerian MSM in this study. LGV needs to be considered even in asymptomatic cases, particularly if anorectal CT infection fails to respond to the usual course of therapy. Consistent screening for L serovars of CT, or empiric treatment for LGV in cases with a high suspicion for this diagnosis, could potentially improve patient outcomes and decrease transmission. Disclosures All authors: No reported disclosures.

Download Full-text

High-resolution genotyping of Lymphogranuloma Venereum (LGV) strains of Chlamydia trachomatis in London using multi-locus VNTR analysis-ompA genotyping (MLVA-ompA)

PLoS ONE ◽

10.1371/journal.pone.0254233 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254233

Author(s):

Chloe Manning ◽

Colette O’Neill ◽

Ian N. Clarke ◽

Monica Rebec ◽

Penelope R. Cliff ◽

...

Keyword(s):

High Resolution ◽

Chlamydia Trachomatis ◽

Protein A ◽

Lymphogranuloma Venereum ◽

Nucleic Acid Amplification ◽

Study Population ◽

Monitoring And Surveillance ◽

Sex With Men ◽

The Uk ◽

Vntr Analysis

Background Lymphogranuloma venereum (LGV) is caused by Chlamydia trachomatis strains with ompA genotypes L1 to L3. An LGV epidemic associated with the L2b genotype has emerged in the past few decades amongst men who have sex with men (MSM). C. trachomatis genotypes can be discriminated by outer membrane protein A gene (ompA) sequencing, however this method has limited resolution. This study employed a high-resolution genotyping method, namely, multi-locus tandem repeat (VNTR) analysis with ompA sequencing (MLVA-ompA), to assess the distribution of LGV MLVA-ompA genotypes amongst individuals attending genitourinary medicine (GUM) clinics in London. Methods Clinical specimens were collected from individuals attending eight London-based GUM clinics. Specimens that tested positive for C. trachomatis by commercial nucleic acid amplification test (NAAT) were confirmed as LGV by pmpH real-time PCR. LGV-positive DNA extracts were subsequently genotyped using MLVA-ompA. Results Two hundred and thirty DNA extracts were confirmed as LGV, and 162 (70%) yielded complete MLVA-ompA genotypes. Six LGV MLVA-ompA genotypes were identified: 1.9.2b-L2, 1.9.3b-L2b, 1.9.2b-L2b, 1.9.2b-L2b/D, 1.4a.2b-L2b, and 5.9.2b-L1. The following LGV ompA genotypes were identified (in descending order of abundance): L2, L2b, L2b/D, and L1. Eight ompA sequences with the hybrid L2b/D profile were detected. The hybrid sequence was identical to the ompA of a recombinant L2b/D strain detected in Portugal in 2017. Conclusions The L2 ompA genotype was found to predominate in the London study population. The study detected an unusual hybrid L2b/D ompA profile that was previously reported in Portugal. We recommend further monitoring and surveillance of LGV strains within the UK population.

Download Full-text

Prevalence and correlates of and a risk score to identify asymptomatic anorectal gonorrhoea and chlamydia infection among men who have sex with men in Kisumu, Kenya

Sexually Transmitted Infections ◽

10.1136/sextrans-2018-053613 ◽

2018 ◽

Vol 95 (3) ◽

pp. 201-211 ◽

Cited By ~ 4

Author(s):

Laura A S Quilter ◽

Eve Obondi ◽

Colin Kunzweiler ◽

Duncan Okall ◽

Robert C Bailey ◽

...

Keyword(s):

Risk Score ◽

Diagnostic Testing ◽

Nucleic Acid Amplification ◽

Chlamydia Infection ◽

Number Needed To Treat ◽

Infection Prevalence ◽

Presumptive Treatment ◽

Sex With Men ◽

Sensitivity Specificity ◽

Asymptomatic Men

ObjectivesIn settings where laboratory capacity is limited, the WHO recommends presumptive treatment for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) in asymptomatic men who have sex with men (MSM) at high risk for these infections. However, little is known about how best to target this intervention. We aimed to identify correlates of anorectal NG/CT infection in Kenyan MSM with and without anorectal symptoms and evaluate the performance of an empirical, model-based risk score to identify cases in asymptomatic men.MethodsAnorectal NG/CT infections were diagnosed by the Abbott RealTime NG/CT nucleic acid amplification testamong 698 MSM at enrolment into the Anza Mapema study. Multivariable logistic regression was used to identify correlates of anorectal NG/CT infection in men with and without anorectal symptoms. Using coefficients from the final multivariable model for asymptomatic men, we calculated a risk score for each participant. Risk score performance was determined by calculating the sensitivity, specificity and number needed to treat (NNT) to identify one NG/CT infection.ResultsOverall anorectal NG/CT infection prevalence was 5.2% (n=36), of which 58.3% (n=21) were asymptomatic. Factors associated with anorectal NG/CT infection in asymptomatic men were aged 18–24 years (aOR=7.6; 95% CI: 1.7 to 33.2), HIV positive serostatus (aOR=6.9; 95% CI: 2.2 to 21.6) and unprotected anal sex in the past 3 months (aOR=3.8; 95% CI: 1.2 to 11.9). Sensitivity and specificity were optimal (81.0% and 66.1%, respectively) at a model-derived risk score cut-point ≥3, and the NNT was 12.ConclusionsA model-derived risk score based on correlates of anorectal NG/CT infection in asymptomatic participants would be sensitive and efficient (i.e, low NNT) for targeting presumptive treatment. If validated in other settings, this risk score could improve on the WHO algorithm and help reduce the burden of asymptomatic anorectal NG/CT infections among MSM in settings where diagnostic testing is not available.

Download Full-text

HIV incidence among men who have sex with men and transgender women in four provinces in Thailand

International Journal of STD & AIDS ◽

10.1177/0956462420921068 ◽

2020 ◽

Vol 31 (12) ◽

pp. 1154-1160

Author(s):

Usanee Kritsanavarin ◽

Emily Bloss ◽

Chomnad Manopaiboon ◽

Thana Khawcharoenporn ◽

Pronnipa Harnlakon ◽

...

Keyword(s):

Anal Intercourse ◽

Transgender Women ◽

Hiv Incidence ◽

Alkyl Nitrites ◽

The Past ◽

Receptive Anal Sex ◽

Observational Cohort ◽

Sex With Men ◽

Using Data

The HIV epidemic in Thailand is concentrated in key populations, with the highest rates in men who have sex with men (MSM) and transgender women (TG). Previous studies of HIV incidence in these groups have been limited mostly to Bangkok. We measured HIV incidence in MSM and TG in four provinces and evaluated factors associated with incident infections to inform public health prevention efforts. An analysis was conducted using data collected during a prospective observational cohort study during April 2015–May 2018 in outpatient clinics in five hospitals across four provinces in Thailand. MSM and TG aged ≥18 years, who were not known to be HIV-infected, and who reported anal intercourse with a male or TG without a condom in the past six months were enrolled. Participants were followed-up every 6 months for 18 months with questionnaires and HIV testing. A total of 40 HIV seroconversions occurred during follow-up, resulting in an HIV incidence of 3.5 per 100 person-years (95% CI 2.5, 4.8). Multivariate analyses indicated that identifying as gay (adjusted hazard ratio [AHR] 4.9; 95% CI 1.7–14.2), having receptive anal sex in the past six months (AHR 3.6; 95% CI 1.4–9.5), using alcohol (AHR 3.3; 95% CI 1.3–8.3), and taking alkyl nitrites (AHR 4.4; 95% CI 1.7–11.2) in the past six months were all independently associated with HIV infection. Overall this study found a lower HIV incidence in the highest risk population in Thailand compared with similar studies in Bangkok. Accelerated prevention efforts are needed to make the goal of ‘zero new infections’ possible in Thailand.

Download Full-text

Lymphogranuloma venereum – the first Hungarian cases

Orvosi Hetilap ◽

10.1556/oh.2015.30083 ◽

2015 ◽

Vol 156 (1) ◽

pp. 36-40

Author(s):

András Bánvölgyi ◽

Eszter Balla ◽

Péter Bognár ◽

Béla Tóth ◽

Eszter Ostorházi ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Western Europe ◽

Lymphogranuloma Venereum ◽

Nucleic Acid Amplification ◽

Diagnostic Challenge ◽

Transmitted Infection ◽

Rectal Pain ◽

Urethral Discharge ◽

Immunodeficiency Virus ◽

Sex With Men

Lymphogranuloma venereum is a sexually transmitted infection caused by the Chlamydia trachomatis serovars L1–3. It has been found to be endemic in tropical countries. In the last decades several cases have been reported in Western Europe, particularly in men who have sex with men population infected with human immunodeficiency virus. The authors present three cases of lymphogranuloma venereum infections, observed at their department in 2013 and 2014. The three human immunodeficiency virus infected patients who belonged to men who have sex with men population had casual sexual contacts in Western Europe. The symptoms included urethral discharge, discomfort and inguinal lymphadenomegaly in two patients, and rectal pain, discharge and perianal ulceration in one patient. The diagnosis was confirmed by nucleic acid amplification test performed in samples obtained from urethral discharge and exudate of perianal ulcer; lymphogranuloma venereum 2b serovars were demonstrated in two patients and serovar 2 in one patient. Doxycyclin (daily dose of two times 100 mg for 21 days) resolved the symptoms in all cases. The authors conclude that lymphogranuloma venereum is a diagnostic challenge in Hungary, too. It is important to be aware of the altered clinical features of this disease to prevent complications and spreading. Orv. Hetil., 2015, 156(1), 36–40.

Download Full-text

Doxycycline Versus Azithromycin for the Treatment of Rectal Chlamydia in Men Who Have Sex With Men: A Randomized Controlled Trial

Clinical Infectious Diseases ◽

10.1093/cid/ciab153 ◽

2021 ◽

Author(s):

Julia C Dombrowski ◽

Michael R Wierzbicki ◽

Lori M Newman ◽

Jonathan A Powell ◽

Ashley Miller ◽

...

Keyword(s):

Primary Outcome ◽

Controlled Trial ◽

Clinical Care ◽

Nucleic Acid Amplification ◽

Absolute Difference ◽

Complete Case ◽

Double Blind ◽

Intention To Treat ◽

Sex With Men

Abstract Background Azithromycin and doxycycline are both recommended treatments for rectal Chlamydia trachomatis (CT) infection, but observational studies suggest that doxycycline may be more effective. Methods This randomized, double-blind, placebo-controlled trial compared azithromycin (single 1-g dose) versus doxycycline (100 mg twice daily for 7 days) for the treatment of rectal CT in men who have sex with men (MSM) in Seattle and Boston. Participants were enrolled after a diagnosis of rectal CT in clinical care and underwent repeated collection of rectal swabs for nucleic acid amplification testing (NAAT) at study enrollment and 2 weeks and 4 weeks postenrollment. The primary outcome was microbiologic cure (CT-negative NAAT) at 4 weeks. The complete case (CC) population included participants with a CT-positive NAAT at enrollment and a follow-up NAAT result; the intention-to-treat (ITT) population included all randomized participants. Results Among 177 participants enrolled, 135 (76%) met CC population criteria for the 4-week follow-up visit. Thirty-three participants (19%) were excluded because the CT NAAT repeated at enrollment was negative. Microbiologic cure was higher with doxycycline than azithromycin in both the CC population (100% [70 of 70] vs 74% [48 of 65]; absolute difference, 26%; 95% confidence interval [CI], 16–36%; P < .001) and the ITT population (91% [80 of 88] vs 71% [63 of 89]; absolute difference, 20%; 95% CI, 9–31%; P < .001). Conclusions A 1-week course of doxycycline was significantly more effective than a single dose of azithromycin for the treatment of rectal CT in MSM. Clinical Trials Registration ClinicalTrials.gov (NCT03608774).

Download Full-text

Personality, Cardiovascular Disease, and Cancer:

Zeitschrift für Gesundheitspsychologie ◽

10.1026/0943-8149.12.3.102 ◽

2004 ◽

Vol 12 (3) ◽

pp. 102-115 ◽

Cited By ~ 9

Author(s):

Manfred Amelang ◽

Petra Hasselbach ◽

Til Stürmer

Keyword(s):

Cardiovascular Disease ◽

Behavioral Control ◽

Smoking Behavior ◽

Type A Behavior ◽

Incremental Validity ◽

Personality Factors ◽

Emotional Lability ◽

Prevalent Disease ◽

Incident Cardiovascular Disease

Abstract. Ten years ago a sample of N = 5.133 male and female subjects (age 28-74) responded to questionnaires including scales for personality, life style, work stress as well as questions on prevalent disease. We now report on the follow-up regarding self-reported incidence of cardiovascular disease and cancer. During a mean follow-up of 10 years, 257 participants had died. Of those alive, N = 4.010 (82%) participated in the follow-up. Of these, 120 and 180 persons reported incident cardiovascular disease and cancer, respectively. The incidence of cardiovascular disease could be significantly predicted by the personality factors “Emotional Lability”, “Behavioral Control” and “Type-A-Behavior” as well as by the “Rationality/Antemotionality”-scale according to Grossarth-Maticek. After controlling for age, gender and smoking behavior only the significant effect of “Emotional Lability” remained and the predictors according to Grossarth-Maticek had no incremental validity. Cancer could not be predicted by any personality factors.

Download Full-text

Pediatrics’ Total Parenteral Nutrition: Initiative and implementation of standardized formulation in Saudi Arabia

Research in Pharmacy and Health Sciences ◽

10.32463/rphs.2018.v04i03.16 ◽

2018 ◽

Vol 4 (3) ◽

pp. 492-496

Author(s):

Yousef Ahmed Alomi ◽

Hussam Saad Almalki ◽

Aisha Omar Fallatah ◽

Awatif Faraj Alshammari ◽

Nesreen Al-Shubbar

Keyword(s):

Saudi Arabia ◽

Clinical Outcome ◽

Parenteral Nutrition ◽

Drug Related Problems ◽

Kingdom Of Saudi Arabia ◽

Parental Nutrition ◽

Management Project ◽

Improve Patient ◽

New System

The national total parental nutrition program with an emphasis on pediatrics started before several ago at Ministry of health hospitals In Kingdom of Saudi Arabia. The program covered several regions and consisted from the foundation of Intravenous Admixture and preparation of pediatric parenteral nutrition to administration and follow up of patients outcomes. In addition to the prior system, the new initiative project with the standardized formulation of pediatric’s parenteral nutrition is the complementary project of the parental nutrition for pediatrics. The project initiated to prevent drug-related problems of parental nutrition, improve patient clinical outcome and reduce the unnecessary economic burden on the healthcare system. It is the new system in the Middle East and Gulf counties in additional to Saudi Arabia. The initiatives are the systemic implementation of standardized pediatrics formulation using management project tools of starting new idea until finding in the ground.

Download Full-text