title: Challenges Presented by Re-Emerging Sexually Transmitted Infections in HIV Positive Men who have Sex with Men: An Observational Study of Lymphogranuloma Venereum in the UK.
abstract: BACKGROUND
  United Kingdom has reported the largest documented outbreak of lymphogranuloma venereum (LGV), a re-emerging sexually transmitted infection (STI) which is primarily seen in HIV-positive men who have sex with men (MSM). A diagnostic service was established in response to the outbreak linked to a voluntary LGV Enhanced Surveillance system. We examined the performance of this novel surveillance system to identify utility in tracking a re-emerging infection.
  
  
  METHODS
  We described laboratory data on samples and surveillance data from case reports for LGV from 2004-2010. We performed a cross-sectional analysis comparing clinical and behavioural characteristics of HIV-positive and HIV-negative/unknown LGV cases diagnosed in MSM using multivariable logistic regression models with generalised estimating equations to control for repeat infections.
  
  
  RESULTS
  LGV Surveillance data were available for 87% (1,370/1,581) of LGV cases (after de-duplication). There were 1,342 episodes in 1,281 MSM, most of whom were known to be HIV-positive (1,028/1,281, 80.2%,). HIV-positive men reported a shorter duration of symptoms (aOR 0.5; 95%CI 0.3, 0.8 for reporting more than a week compared to a week or less) in comparison to HIV-negative/unknown MSM, and were more likely to report unprotected receptive anal intercourse (aOR 2.7; 95% CI 1.3, 5.8).
  
  
  CONCLUSIONS
  The surveillance identified the population at greater risk of infection based on higher levels of risk behaviour in HIV-positive LGV cases. However, there was diagnostic bias towards HIV-positive LGV cases who presented with a shorter duration of symptoms when compared to HIV-negative/unknown LGV cases.
authors: Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.
authors: Minttu
authors: M
authors: Rönn
authors: STI Section at the Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
authors: Gwenda
authors: G
authors: Hughes
authors: STI Section at the Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
authors: Ian
authors: I
authors: Simms
authors: Sexually Transmitted Bacteria Reference Unit, Public Health England, London, UK.
authors: Cathy
authors: C
authors: Ison
authors: Sexually Transmitted Bacteria Reference Unit, Public Health England, London, UK.
authors: Sarah
authors: S
authors: Alexander
authors: MRC Centre for Outbreak Analysis and Modelling and NIHR Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK ; Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
authors: Peter J
authors: PJ
authors: White
authors: Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.
authors: Helen
authors: H
authors: Ward
keywords: HIV; Lymphogranuloma venereum; Men who have sex with men; Surveillance