title: Characteristics of LGV repeaters: analysis of LGV surveillance data.
abstract: OBJECTIVE
  A number of individuals have acquired lymphogranuloma venereum (LGV) infection multiple times since its re-emergence. We describe the characteristics of reinfections and those who acquire them.
  
  
  METHODS
  The LGV Enhanced Surveillance system collected detailed information on LGV episodes in the U.K. from 2004 to 2010. Using logistic regression we compared the baseline characteristics of men who have sex with men (MSM) who had a repeat LGV episode ('repeaters') to MSM with a single reported episode ('non-repeaters').
  
  
  RESULTS
  There were 66 individuals among the 1281 MSM (5.2%) with LGV episode who had a recorded reinfection during the data collection period. Those who acquired LGV reinfection were more likely to be HIV positive (97% vs 79%), visit a clinic in London (OR 2.0, 95% CI 1.1 to 3.8), and have hepatitis C (OR 2.2, 95% CI 1.1 to 4.6) or concurrent gonorrhoea (OR 2.2, 95% CI 1.2 to 3.8) on their first recorded LGV episode. Repeaters reported higher levels of unprotected sex, but behavioural variables were not significantly different between repeaters and non-repeaters.
  
  
  CONCLUSIONS
  Among LGV repeaters, risk behaviour alone did not explain subsequent reinfection. LGV repeaters have a high level of other sexually transmitted infections (STIs) which may be linked to their central position in the sexual network that contributes to their heightened risk of STI acquisition. Given the low prevalence of LGV in the general MSM population, momentary increases in incidence in subsets of the population may be an important factor for LGV risk where the overall level of sexual risk behaviour is higher. Validating this would require research into sexual network structures.
authors.affiliation: Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
authors.forename: Minttu
authors.initials: M
authors.lastname: Rönn
authors.affiliation: Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
authors.forename: Gwenda
authors.initials: G
authors.lastname: Hughes
authors.affiliation: Modelling and Economics Unit, Public Health England, London, UK Department of Infectious Disease Epidemiology, MRC Centre for Outbreak Analysis and Modelling, Imperial College London, London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: White
authors.affiliation: Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Simms
authors.affiliation: Sexually Transmitted Bacteria Reference Laboratory, Public Health England, London, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Ison
authors.affiliation: Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Ward
mesh_terms: D000328:Adult; D005843:Geography; D006069:Gonorrhea / Q000453:epidemiology*; D015658:HIV Infections / Q000453:epidemiology*; D006526:Hepatitis C / Q000453:epidemiology*; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008131:London / Q000453:epidemiology; D008219:Lymphogranuloma Venereum / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000453:epidemiology*; D012008:Recurrence; D012307:Risk Factors; D012725:Sexual Behavior / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology; D047568:Unsafe Sex / Q000706:statistics & numerical data*
keywords: HOMOSEXUALITY; INFECTION CONTROL; LYMPHOGRANULOMA VENEREUM