Department of Dermatology, University Hospital, Zurich, Switzerland.
Swiss Med Wkly. 2010 Apr 3;140(13-14):209-12. doi: 10.4414/smw.2010.12962.
Whereas until 2003 Lymphogranuloma venereum (LGV) was rare in industrialised countries, there have been increasing reports of cases of LGV proctitis in men having sex with men (MSM) over the last six years in Europe, America and Australia.
After the alarming message from the Netherlands in 2003, physicians in a dermatological and STI private clinic in Zurich started examining rectal swabs from patients with proctitis for LGV serovars of C. trachomatis on a regular basis. A test system based on PCR with sequencing and databank comparison was used. Clinical files of all patients with proctitis observed in this time period were examined.
Since 2003 twelve cases of proctitis, all in MSM, caused by the LGV serovar L2 C. trachomatis were observed. Of the overall 11 patients the majority were HIV positive and only 2 were HIV negative. Only one patient reported previous sexual contacts outside Europe (Thailand) as the likely place of infection. The clinical presentation was characterised by anorectal pain, discharge, tenesmus and change in stool frequency. Four patients were successfully treated with a single dose of 1 g azithromycin. In all seven cases treated with doxycycline 2 x 100 mg for 10-20 days clinical cure and a negative PCR result after treatment were observed, except for one patient lost to follow-up.
Zurich has not been spared by the recent outbreaks of LGV proctitis in MSM. Anorectal LGV infections may progress to severe destructive changes, with formation of granulomas, strictures, and perirectal abscesses. Increased awareness of this problem and establishment of reliable diagnostic tools are required.
直到 2003 年，淋菌肉芽肿（LGV）在工业化国家很少见，但在过去六年中，欧洲、美洲和澳大利亚的男男性接触者（MSM）中，LGV 直肠炎的病例报告越来越多。
2003 年荷兰发出警报后，苏黎世一家皮肤科和性传播感染私人诊所的医生开始定期检查直肠拭子中是否存在沙眼衣原体 LGV 血清型，用于 LGV 直肠炎。使用基于 PCR 测序和数据库比较的检测系统。检查了在此期间观察到的所有直肠炎患者的临床档案。
自 2003 年以来，观察到 12 例 LGV 血清型 L2 沙眼衣原体引起的直肠炎，均发生在 MSM 中。在总共 11 例患者中，大多数 HIV 阳性，只有 2 例 HIV 阴性。只有 1 例患者报告在欧洲以外（泰国）有过性接触，可能是感染源。临床表现为肛门直肠疼痛、分泌物、里急后重和粪便频率改变。4 例患者单次使用 1 g 阿奇霉素成功治疗。在所有 7 例接受多西环素治疗的患者中，2x100mg，治疗 10-20 天，临床治愈，治疗后 PCR 结果阴性，除 1 例失访患者外。
苏黎世也未能幸免最近在 MSM 中爆发的 LGV 直肠炎。肛门直肠 LGV 感染可能会发展为严重的破坏性改变，形成肉芽肿、狭窄和直肠周围脓肿。需要提高对这一问题的认识，并建立可靠的诊断工具。
