title: Anorectal and inguinal lymphogranuloma venereum among men who have sex with men in Amsterdam, The Netherlands: trends over time, symptomatology and concurrent infections.
abstract: OBJECTIVE
  To examine lymphogranuloma venereum (LGV) trends over time among men who have sex with men (MSM) visiting the Amsterdam sexually transmitted infection (STI) clinic; to investigate anal LGV symptomatology; and to examine the positivity and characteristics of anorectal and inguinal LGV.
  
  
  METHODS
  We included MSM consultations from whom a swab (from anorectum, bubo or an genital ulcer) was taken for Chlamydia trachomatis (Ct) screening. Anorectal swabs were taken from all MSM who reported receptive anorectal intercourse in the preceding 6 months. Ct positive samples were further tested with a pmpH PCR to identify L-genovars. Patient symptoms, clinical and anoscopic inflammatory signs, and STI co-infections were noted; Gram-stained anorectal mucosal smears were examined.
  
  
  RESULTS
  Between January 2005 and June 2012, 48 570 consultations among MSM were conducted. In 3628/35 650 visits, anorectal Ct infections were diagnosed, including 411 anal LGV (1.2%). Moreover, 65/1649 genital ulcer swabs were Ct positive; 10 were inguinal LGV (0.6%) Since January 2011 a significant increase in the positivity of LGV occurred (p<0.0001). 89 (27.2%) anorectal LGV cases were asymptomatic. HIV prevalence among anorectal LGV cases was significantly higher (p=0.008) than among inguinal LGV cases. STI co-morbidity in anorectal LGV cases remained invariably high during the study period.
  
  
  CONCLUSIONS
  Since January 2011, LGV positivity in MSM consultations in Amsterdam has risen significantly. The great majority comprise anal LGV; inguinal LGV is rare. Anal LGV is asymptomatic in a quarter of cases. In all MSM with anal Ct infections LGV should be excluded, irrespective of symptoms or inflammatory signs.
authors: STI Outpatient Clinic, Cluster of Infectious diseases, Public Health Service Amsterdam, , Amsterdam, The Netherlands.
authors: Nynke Hesselina Neeltje
authors: NH
authors: de Vrieze
authors: Martijn
authors: M
authors: van Rooijen
authors: Maarten Franciscus
authors: MF
authors: Schim van der Loeff
authors: Henry John C
authors: HJ
authors: de Vries
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000473:pathology; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D060085:Coinfection / Q000453:epidemiology / Q000473:pathology; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D007264:Inguinal Canal / Q000473:pathology; D008219:Lymphogranuloma Venereum / Q000453:epidemiology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology
keywords: CHLAMYDIA TRACHOMATIS; EPIDEMIOLOGY (CLINICAL); HIV; HOMOSEXUALITY; LYMPHOGRANULOMA VENEREUM