title: Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case-control study in the U.K.
abstract: OBJECTIVE
  Since 2003, over 2000 cases of lymphogranuloma venereum (LGV) have been diagnosed in the U.K. in men who have sex with men (MSM). Most cases present with proctitis, but there are limited data on how to differentiate clinically between LGV and other pathology. We analysed the clinical presentations of rectal LGV in MSM to identify clinical characteristics predictive of LGV proctitis and produced a clinical prediction model.
  
  
  METHODS
  A prospective multicentre case-control study was conducted at six U.K. hospitals from 2008 to 2010. Cases of rectal LGV were compared with controls with rectal symptoms but without LGV.
  
  
  METHODS
  Data from 98 LGV cases and 81 controls were collected from patients and clinicians using computer-assisted self-interviews and clinical report forms. Univariate and multivariate logistic regression was used to compare symptoms and signs. Clinical prediction models for LGV were compared using receiver operating curves.
  
  
  RESULTS
  Tenesmus, constipation, anal discharge and weight loss were significantly more common in cases than controls. In multivariate analysis, tenesmus and constipation alone were suggestive of LGV (OR 2.98, 95% CI 0.99 to 8.98 and 2.87, 95% CI 1.01 to 8.15, respectively) and that tenesmus alone or in combination with constipation was a significant predictor of LGV (OR 6.97, 95% CI 2.71 to 17.92). The best clinical prediction was having one or more of tenesmus, constipation and exudate on proctoscopy, with a sensitivity of 77% and specificity of 65%.
  
  
  CONCLUSIONS
  This study indicates that tenesmus alone or in combination with constipation makes a diagnosis of LGV in MSM presenting with rectal symptoms more likely.
authors.affiliation: Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
authors.forename: S N S
authors.initials: SN
authors.lastname: Pallawela
authors.affiliation: Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
authors.forename: A K
authors.initials: AK
authors.lastname: Sullivan
authors.affiliation: Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Macdonald
authors.affiliation: Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: French
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: White
authors.affiliation: Brighton & Sussex University Hospitals NHS Trust, Claude Nicol Centre, Brighton, UK.
authors.forename: G
authors.initials: G
authors.lastname: Dean
authors.affiliation: Jefferiss Wing Centre for Sexual Health, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Smith
authors.affiliation: Sandyford Sexual Health Services, Glasgow, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Winter
authors.affiliation: Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Mandalia
authors.affiliation: Sexually Transmitted Bacterial Reference Laboratory, Public Health England, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Alexander
authors.affiliation: Sexually Transmitted Bacterial Reference Laboratory, Public Health England, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Ison
authors.affiliation: Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.
authors.forename: H
authors.initials: H
authors.lastname: Ward
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003248:Constipation / Q000209:etiology*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D015658:HIV Infections / Q000150:complications; D018451:Homosexuality, Male; D006801:Humans; D016015:Logistic Models; D008219:Lymphogranuloma Venereum / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010146:Pain / Q000209:etiology*; D011349:Proctitis / Q000209:etiology; D011351:Proctoscopy; D011446:Prospective Studies; D012002:Rectal Diseases / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D012680:Sensitivity and Specificity; D006113:United Kingdom; D015431:Weight Loss
keywords: CLINICAL PREDICTORS; LYMPHOGRANULOMA VENEREUM; MSM; PROCTITIS; SEXUALLY TRANSMITTED INFECTION