Prevalence, Treatment, and Follow-Up for Lymphogranuloma Venereum Serovars of Chlamydia trachomatis Among Gay, Bisexual, and Other Men Who Have Sex With Men Attending Sexually Transmitted Infection Clinics in Alberta, Canada, 2018 to 2022.

BACKGROUND

Outbreaks of lymphogranuloma venereum (LGV) have been reported among gay, bisexual, and men who have sex with other men (gbMSM) in Europe and North America. In Alberta, Canada, a universal surveillance program was initiated to assess LGV rates among gbMSM seen at provincial sexually transmitted infection clinics. Our study examines the epidemiological characteristics and treatment of cases.

METHODS

We describe a prospective, multicenter LGV surveillance program using chlamydia-positive nucleic acid amplification test specimens from gbMSM collected at 3 sexually transmitted infection clinics between April 2018 and July 2022. Chlamydia-positive specimens from rectal, pharyngeal, and urine specimens were sent for LGV typing. Treatment and test of cure for LGV-confirmed cases were followed. Demographic variables were compared between LGV-positive and LGV-negative specimens using χ2 tests for categorical variables and Mann-Whitney U tests for continuous variables.

RESULTS

Eighty-five percent (n = 2333) of all chlamydia-positive specimens were tested for LGV, and 45 (1.9%; 95% confidence interval, 1.4%-2.5%) specimens were confirmed to be LGV. A majority (n = 1374) of specimens submitted for LGV testing were rectal swabs, of which 37 (2.7%) were positive. One-half (51.2% [22 of 43]) of cases were asymptomatic. Of the 22 cases with a negative test-of-cure result, 9 (40.9%) patients received doxycycline 100 mg twice a day for 21 days, 7 (31.8%) patients received azithromycin 1 g as a single dose, 5 (22.7%) patients received doxycycline 100 mg twice a day for 7 days, and 1 patient (4.6%) was treated with doxycycline 100 mg twice a day for 14 days.

CONCLUSIONS

Universal testing increased the detection of LGV among asymptomatic patients. Future research should consider the impact of asymptomatic LGV in transmission networks and the role of alternate, shorter treatment regimens than the recommended 21 days of doxycycline.