title: Lymphogranuloma venereum presenting as genital ulceration and inguinal syndrome in men who have sex with men in London, UK.
abstract: OBJECTIVE
  To describe a series of lymphogranuloma venereum (LGV) cases presenting as inguinal syndrome and/or genital ulceration seen among men who have sex with men (MSM) in London, UK.
  
  
  METHODS
  Collaborative retrospective case note review. Clinicians from three London genitourinary medicine (GUM) clinics accessed by large populations of MSM within the current LGV outbreak collected clinical data from confirmed cases of LGV inguinal syndrome or genital ulcer. LGV was confirmed by the detection of LGV-specific DNA from specimens such as bubo aspirates, ulcer swabs, urethral swabs, first void urine and rectal biopsy material.
  
  
  RESULTS
  There were 13 cases detected overall: 5 cases of urethral LGV infection with inguinal adenopathy, 3 cases of genital ulcer with LGV inguinal adenopathy, 3 cases of isolated LGV-associated inguinal buboes, 1 case of a solitary LGV penile ulcer and 1 case with a penile ulcer and bubonulus. Only 6 of the 13 were HIV positive and all tested negative for hepatitis C. The majority of cases reported few sexual contacts in the 3 months preceding their diagnosis.
  
  
  CONCLUSIONS
  Clinical manifestations of LGV in MSM have not been confined to proctitis in the current outbreak in the UK and a small but significant number of inguinogenital cases of LGV have been observed. Epidemiologically, many of the cases described seem to have occurred at the periphery of the current MSM LGV epidemic. Clinicians need to be vigilant for these less common presentations of LGV among MSM and specific diagnostic tests should be done from the relevant lesions.
authors.affiliation: Department of Genitourinary Medicine, Guy's and St Thomas' NHS Foundation Trust, Lambeth Palace Road, London, SE1 7EH, UK.
authors.forename: G
authors.initials: G
authors.lastname: Sethi
authors.forename: E
authors.initials: E
authors.lastname: Allason-Jones
authors.forename: J
authors.initials: J
authors.lastname: Richens
authors.forename: N T
authors.initials: NT
authors.lastname: Annan
authors.forename: D
authors.initials: D
authors.lastname: Hawkins
authors.forename: A
authors.initials: A
authors.lastname: Ekbote
authors.forename: S
authors.initials: S
authors.lastname: Alexander
authors.forename: J
authors.initials: J
authors.lastname: White
mesh_terms: D000328:Adult; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D003430:Cross-Sectional Studies; D005832:Genital Diseases, Male / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology; D018451:Homosexuality, Male; D006801:Humans; D008131:London / Q000453:epidemiology; D008219:Lymphogranuloma Venereum / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014456:Ulcer / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult