The prevalence of lymphogranuloma venereum infection in men who have sex with men: results of a multicentre case finding study.

OBJECTIVE

To determine the prevalence of lymphogranuloma venereum (LGV) and non-LGV associated serovars of urethral and rectal Chlamydia trachomatis (CT) infection in men who have sex with men (MSM).

DESIGN

Multicentre cross-sectional survey.

SETTING

Four genitourinary medicine clinics in the United Kingdom from 2006-7.

SUBJECTS: 4825 urethral and 6778 rectal samples from consecutive MSM attending for sexual health screening.

METHODS

Urethral swabs or urine and rectal swabs were tested for CT using standard nucleic acid amplification tests. Chlamydia-positive specimens were sent to the reference laboratory for serovar determination.

MAIN OUTCOME: Positivity for both LGV and non-LGV associated CT serovars; proportion of cases that were symptomatic.

RESULTS

The positivity (with 95% confidence intervals) in rectal samples was 6.06% (5.51% to 6.66%) for non-LGV CT and 0.90% (0.69% to 1.16%) for LGV; for urethral samples 3.21% (2.74% to 3.76%) for non-LGV CT and 0.04% (0.01% to 0.16%) for LGV. The majority of LGV was symptomatic (95% of rectal, one of two urethral cases); non-LGV chlamydia was mostly symptomatic in the urethra (68%) but not in the rectum (16%).

CONCLUSIONS

Chlamydial infections are common in MSM attending for sexual health screening, and the majority are non-LGV associated serovars. We did not identify a large reservoir of asymptomatic LGV in the rectum or urethra. Testing for chlamydia from the rectum and urethra should be included for MSM requesting a sexual health screen, but serovar-typing is not indicated in the absence of symptoms. We have yet to identify the source of most cases of LGV in the UK.