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Lymphogranuloma Venereum in a Public Health Service Hospital in Southern Spain: A Clinical and Epidemiologic Study
J B Repiso-Jiménez1, J F Millán-Cayetano1, C Salas-Márquez1
1Área de Dermatología, Empresa Pública Hospital Costa del Sol, Marbella, Málaga, España.
Abstract:
Lymphogranuloma venereum (LGV) is an emerging disease in men who have sex with men (MSM): the incidence was 1.15 cases per 100,000 population in Spain in 2017. Patients with LGV characteristically have severe proctitis that can cause abscesses, fistulas, and anal stenosis. Genital ulcers and inflammatory inguinal adenopathy may occasionally be present. The aim of this study was to describe a series of patients with LGV treated in a public health service hospital in Andalusia, Spain.
Material And Methods:
Retrospective, observational description of a series of patients diagnosed with LGV. We gathered epidemiologic, clinical, microbiologic, and treatment data. Patients' sexual behaviors were also noted.
Results:
We found 17 cases of LGV diagnosed in MSM between October 2016 and May 2019. Twelve of the patients were also infected with the human immunodeficiency virus, and 13 had severe proctitis with ulcers in the anal canal and rectum. Four patients had genital or inguinal manifestations. The following high-risk sexual behaviors were on record: a high number of sexual partners, receptive anal sex with strangers and without a condom, seeking sexual partners online, participation in group sex, and sex with partners from outside Andalusia. Chlamydia trachomatis serovar L2 was identified in all cases, and the infection responded well to oral doxycycline. Two patients with the most characteristic form of LGV required longer treatment cycles. Three required surgery.
Conclusions:
When symptomatic proctitis is found in MSM who engage in high-risk sex, the LGV exudate should be sampled and the C trachomatis serovar identified. Genital ulcers or inguinal buboes are also highly suggestive of LGV. Clinical suspicion and early treatment are the keys to preventing complications and disease transmission.
Insights
Lymphogranuloma venereum (LGV) is an emerging infection in men who have sex with men (MSM), often presenting as severe proctitis. Early diagnosis and treatment are crucial for preventing complications and transmission of this Chlamydia trachomatis infection.
Area of Science:
- Infectious Diseases
- Public Health
- Sexually Transmitted Infections
Background:
- Lymphogranuloma venereum (LGV) is an emerging sexually transmitted infection (STI) particularly affecting men who have sex with men (MSM).
- LGV can lead to severe proctitis, potentially causing abscesses, fistulas, and anal stenosis.
- While proctitis is characteristic, genital ulcers and inguinal adenopathy can also occur.
Purpose of the Study:
- To describe a series of Lymphogranuloma venereum (LGV) cases treated within a public health service hospital in Andalusia, Spain.
- To analyze the epidemiological, clinical, and microbiological characteristics of LGV in affected patients.
- To evaluate treatment outcomes and identify key factors for preventing complications.
Main Methods:
- Retrospective, observational study design.
- Data collection included epidemiologic, clinical, microbiological, and treatment information.
- Patient sexual behaviors were also documented.
Main Results:
- Seventeen cases of LGV were diagnosed in MSM between October 2016 and May 2019.
- Twelve patients were co-infected with human immunodeficiency virus (HIV).
- Thirteen patients presented with severe proctitis; four had genital or inguinal manifestations. Chlamydia trachomatis serovar L2 was identified in all cases and responded well to doxycycline, though two patients required extended treatment and three needed surgery.
Conclusions:
- Symptomatic proctitis in MSM engaging in high-risk sexual behaviors warrants investigation for LGV, including sampling for Chlamydia trachomatis serovar identification.
- Genital ulcers or inguinal buboes are highly suggestive of LGV.
- Clinical suspicion and prompt treatment are essential to prevent LGV complications and onward transmission.
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