Prevalence and predictors of Lymphogranuloma venereum in a high risk population attending a STD outpatients clinic in Italy.
BACKGROUND
We evaluated LGV prevalence and predictors in a high risk population attending a STI Outpatients Clinic in the North of Italy.


METHODS
A total of 108 patients (99 MSM and 9 women), with a history of unsafe anal sexual intercourses, were enrolled. Anorectal swabs and urine samples were tested for Chlamydia trachomatis (CT) DNA detection by Versant CT/GC DNA 1.0 Assay (Siemens Healthcare Diagnostics Terrytown, USA). RFLP analysis was used for CT molecular typing.


RESULTS
L2 CT genotype was identified in 13/108 (12%) rectal swabs. All LGV cases were from MSM, declaring high-risk sexual behaviour and complaining anorectal symptoms. Patients first attending the STI Outpatient Clinic received a significant earlier LGV diagnosis than those first seeking care from general practitioners or gastroenterologists (P = 0.0046). LGV prevalence and characteristics found in our population are in agreement with international reports. Statistical analysis showed that LGV positive patients were older (P = 0.0008) and presented more STIs (P = 0.0023) than LGV negative ones, in particular due to syphilis (P < 0.001), HIV (P < 0.001) and HBV (P = 0.001).Multivariate logistic regression analysis revealed that HIV and syphilis infections are strong risk factors for LGV presence (respectively, P = 0.001 and P = 0.010).


CONCLUSIONS
Even if our results do not provide sufficient evidence to recommend routine screening of anorectal swabs in high-risk population, they strongly suggest to perform CT NAAT tests and genotyping on rectal specimens in presence of ulcerative proctitis in HIV and/or syphilis-positive MSM. In this context, CT DNA detection by Versant CT/GC DNA 1.0 Assay, followed by RFLP analysis for molecular typing demonstrated to be an excellent diagnostic algorithm for LGV identification.
Claudio
C
Foschi
Microbiology, DIMES, University of Bologna, St, Orsola Hospital, Via Massarenti, 9, 40138 Bologna, Italy. antonella.marangoni@unibo.it.
Antonella
A
Marangoni
Antonietta
A
D'Antuono
Paola
P
Nardini
Monica
M
Compri
Sara
S
Bellavista
Andrea
A
Filippini
Maria Letizia
ML
Bacchi Reggiani
Roberto
R
Cevenini
D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D001003:Anal Canal / Q000382:microbiology* / Q000473:pathology / Q000821:virology; D002692:Chlamydia trachomatis / Q000235:genetics / Q000302:isolation & purification; D060085:Coinfection; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D006509:Hepatitis B / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D018451:Homosexuality, Male; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008219:Lymphogranuloma Venereum / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D058889:Molecular Typing; D010045:Outpatients; D015995:Prevalence; D011349:Proctitis / Q000175:diagnosis / Q000473:pathology; D012307:Risk Factors; D012309:Risk-Taking; D013587:Syphilis / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D047568:Unsafe Sex