NYC Sexual Health Clinics See Rise in Anorectal Lymphogranuloma Venereum

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Investigators note that in the absence of routine screening for anorectal lymphogranuloma venereum infections, it is possible to use clinical findings to monitor disease prevalence among MSM.
Investigators note that in the absence of routine screening for anorectal lymphogranuloma venereum infections, it is possible to use clinical findings to monitor disease prevalence among MSM.

A rise in anorectal lymphogranuloma venereum, a condition caused by Chlamydia trachomatis invasive serovars was observed between 2012 and 2015 in NYC sexual health clinics among men who have sex with men, according to a study published in Sexually Transmitted Diseases.

Study investigators began by testing convenience samples of archived anorectal specimens that screened DNA positive for C trachomatis at the NYC Public Health Laboratory, and then analyzed clinical and symptomatic data to identify clinical predictors for lymphogranuloma venereum that could aid in better management of the condition without a commercially available test.

Of the 301 C trachomatis positive specimens (obtained from 295 individual patients), 16.6% (n=50) screened positive for lymphogranuloma venereum (95% CI, 12.8%-21.3%). The percentage of positivity was 30.0% for the 2012 specimens, 8.3% for 2013, 13.8% for 2014, and 17.4% for 2015. Application of the overall positivity rate of 16.6% to the total 2396 positive diagnoses of anorectal C trachomatis made between 2012 and 2015, would yield 398 cases of anorectal lymphogranuloma venereum over the course of 4 years.

Of the total 295 patients whose C trachomatis positive specimens were tested, 63% (n=186) had anogenital signs and/or symptoms at the time of screening. Of the 186 symptomatic patients, 23% (n=42) screened positive for lymphogranuloma venereum, compared with 6% (n=7) of the 109 asymptomatic patients.

Anogenital signs and symptoms were more prevalent among those who screened positive for lymphogranuloma venereum (86%; 42 of 49) than those who screened negative (58%; 144 of 246). Of the 42 symptomatic patients, 14% (n=6) did not have anorectum-specific signs or symptoms (i.e. rectal bleeding, anorectal pain, anal irritation, anal discharge, tenesmus), and the presence of any anorectal-specific sign or symptom was associated with a 9-fold increased risk of lymphogranuloma venereum (odds ratio=9.0; 95% CI, 4.5-18.1), with anal discharge showing the highest sensitivity and most reliable predictive value (51% and 68%, respectively). Of note, the absence of anal discharge accurately identified 91% of patients without lymphogranuloma venereum.

Study investigators concluded that "[f]or clinicians to properly identify and treat [lymphogranuloma venereum] infections in individual patients, they need access to commercially available, timely diagnostic testing for [lymphogranuloma venereum]. In the absence of such diagnostic testing, an algorithm based on clinical findings and history could be used to guide presumptive treatment."

Reference

Pathela P, Jamison K, Kornblum J, Quinlan T, Halse TA, Schillinger JA. Lymphogranuloma venereum: an increasingly common anorectal infection among men who have sex with men attending New York City sexual health clinics [published online October 1, 2018]. Sex Transm Dis. doi: 10.1097/OLQ.0000000000000921

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