Challenges presented by re-emerging sexually transmitted infections: an observational study of lymphogranuloma venereum in the UK

• Published in: The Lancet (British edition) 2013-11, Vol.382 (S3), p.S86-S86
• Main Authors: Rönn, Minttu, Dr, Hughes, Gwenda, PhD, Simms, Ian, PhD, Ison, Cathy, Prof, Alexander, Sarah, PhD, White, Peter, PhD, Ward, Helen, Prof
• Format: Article
• Language: English
• Subjects: Epidemiology; Health risks; Internal Medicine; Medical research; Observational studies; Risk taking; Sexually transmitted diseases; STD
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(13)62511-8

Abstract Background Lymphogranuloma venereum (LGV) is a rare sexually transmitted infection (STI), a biovar of Chlamydia trachomatis , which re-emerged in 2003 and mainly affects HIV-positive men who have sex with men (MSM). A diagnostic service at the National Reference Laboratory was established in response to the LGV outbreak in the UK, which has been the largest documented in Europe. Surveillance protocol operates through testing patients with symptoms indicative of the infection and their sexual contacts. Additionally, a voluntary enhanced surveillance system was ongoing in 2004–10 in the UK. We assess the utility of the novel surveillance system in light of its strengths and limitations. Methods We described data on samples tested for LGV in 2004–10 in the diagnostic service. These data were analysed together with the LGV enhanced surveillance dataset and we undertook a cross-sectional analysis of clinical and behavioural characteristics between HIV-positive and HIV-negative or unknown cases diagnosed in MSM in 2004–10. We used multivariable logistic regression models with generalised estimating equations to control for repeat infections. The final model was adjusted for clinical and behavioural variables chosen through selection of variables based on a-priori hypotheses and statistical associations. Findings Overall, 11 196 C trachomatis -positive samples were tested for LGV, most of which were from men (10 035 of 11 196 [89·6%]), and most of these were from rectal sites (9138 of 10 035 [91·1%]); 1523 (15·2%) of 10 035 samples in men and four (0·8%) of 531 samples in women were confirmed as LGV. Of those confirmed to have the disease, 1370 (86·7%) of 1581 had a LGV enhanced surveillance form. The enhanced surveillance included 1342 episodes of infection in 1281 MSM and most were known to be HIV positive (1028 of 1281 [80·2%]). In comparison with HIV-negative and unknown cases, HIV-positive men were more likely to report unprotected receptive anal intercourse in the preceding 3 months (adjusted odds ratio [aOR] 2·7, 95% CI 1·3–5·8). However, HIV-positive men were also more likely to report a shorter duration of symptoms before clinic presentation (aOR 0·5, 95% CI 0·3–0·8 for reporting more than a week compared with a week or less), and the recorded information on the clinical variables was more complete for HIV-positive MSM. Interpretation There has been good coverage with the enhanced surveillance data, probably because of its link to a centralised