title: Lymphogranuloma venereum proctitis in men who have sex with men is associated with anal enema use and high-risk behavior.
abstract: OBJECTIVE
  In the industrialized world, lymphogranuloma venereum proctitis (LGVP) has been reported only in men who have sex with men. Factors responsible for the outbreak remain to be elucidated.
  
  
  OBJECTIVE
  The goal of the present work was to elucidate risk factors associated with LGVP.
  
  
  METHODS
  The study design comprised a cross-sectional study including 32 men with LGVP and 93 men without LGVP (22 with gonorrheal proctitis, 30 with a non-LGV chlamydial proctitis, and 41 with proctitis of unknown etiology). Factors associated with LGVP were analyzed by (multinomial) logistic regression.
  
  
  RESULTS
  Comparing men with LGVP with men without LGVP, factors significantly associated with higher risk of LGVP in multivariate analyses were as follows: anal enema use [odds ratio (OR): 7.8, 95% confidence interval (CI): 2.6-23.2], having sex on sex parties (OR: 5.7, 95% CI: 1.5-21.8), and having sex with human immunodeficiency virus-positive partners (OR: 3.2, 95% CI: 1.1-9.3). Evaluating the 4 proctitis groups separately in a multinomial logistic regression model, similar associations between anal enema use and LGVP were found. Men with non-LGV chlamydial proctitis showed less risk behavior than men with LGVP. No substantial difference in risk behavior was found, except for attending sex parties, between men with LGVP, and gonorrheal proctitis or proctitis of unknown etiology.
  
  
  CONCLUSIONS
  Apart from men with LGVP, men with gonorrheal proctitis or proctitis of unknown etiology exhibit high risk behavior. Enema use seems to play a key role in transmission of LGVP, and needs further investigation.
authors: STI Outpatient Clinic, Cluster Infectious Diseases, Public Health Service Amsterdam. The Netherlands. h.j.devries@amc.nl
authors: Henry J C
authors: HJ
authors: de Vries
authors: Akke K
authors: AK
authors: van der Bij
authors: Johan S A
authors: JS
authors: Fennema
authors: Colette
authors: C
authors: Smit
authors: Frank
authors: F
authors: de Wolf
authors: Maria
authors: M
authors: Prins
authors: Roel A
authors: RA
authors: Coutinho
authors: Servaas A
authors: SA
authors: Morré
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004733:Enema / Q000009:adverse effects*; D018451:Homosexuality, Male; D006801:Humans; D016015:Logistic Models; D008219:Lymphogranuloma Venereum / Q000175:diagnosis* / Q000635:transmission; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011349:Proctitis / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D047568:Unsafe Sex