U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.
Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.
Sex Transm Infect. 2018 Dec;94(8):578-581. doi: 10.1136/sextrans-2017-053414. Epub 2018 Jan 29.
Recent outbreaks of anorectal lymphogranuloma venereum (LGV) among men who have sex with men (MSM) have been characterised by proctocolitis requiring extended antibiotic treatment compared with infections caused by other serovars of (CT). We describe the prevalence and clinical features of LGV among Nigerian MSM diagnosed with anorectal CT.
MSM were recruited for this observational cohort in Lagos, Nigeria, using respondent-driven sampling and screened for HIV and bacterial STIs every three months for up to 18 months. Nucleic acid amplification tests for CT were performed on rectal swab specimens. Prevalent and incident cases of anorectal CT underwent additional testing to identify LGV using novel real-time PCR assays specific for the L-serovars of CT.
From April 2014 to July 2016, 420 MSM underwent testing for rectal STIs, of whom 66 (15.7%) had prevalent anorectal CT. Among those without prevalent disease, 68 developed incident infections during 208 person-years of follow-up. Of 134 prevalent and incident cases of anorectal CT, 7 (5.2%) were identified as LGV. None of the seven participants with LGV reported any symptoms. Two of the participants with LGV were simultaneously coinfected with rectal gonorrhoea. HIV coinfection was common among participants with both LGV (n=5, 71%) and non-LGV (n=98, 77%) serovars of CT (P=0.66).
Anorectal LGV was uncommon but present among Nigerian MSM in this study. Consistent screening for L-serovars of CT, or presumptive treatment for LGV in cases with a high suspicion for this diagnosis, could potentially improve patient outcomes and decrease transmission.
最近男男性行为者（MSM）中发生的肛门直肠淋球菌肉芽肿（LGV）爆发与其他 CT 血清型引起的感染相比，具有需要延长抗生素治疗的直肠结肠炎特征。我们描述了在尼日利亚 MSM 中诊断出的肛门直肠 CT 中 LGV 的流行率和临床特征。
本观察性队列研究在尼日利亚拉各斯使用回应驱动抽样招募了 MSM，并在 18 个月内每 3 个月对 HIV 和细菌性性传播感染进行筛查。使用直肠拭子标本对 CT 进行核酸扩增检测。对肛门直肠 CT 的现患和新发病例进行额外检测，使用针对 CT 的 L 血清型的新型实时 PCR 检测来识别 LGV。
从 2014 年 4 月至 2016 年 7 月，420 名 MSM 接受了直肠性传播感染检测，其中 66 名（15.7％）有现患肛门直肠 CT。在没有现有疾病的人群中，在 208 人年的随访期间，有 68 人发生了新发感染。在 134 例现患和新发肛门直肠 CT 病例中，有 7 例（5.2％）被鉴定为 LGV。7 名 LGV 患者均无任何症状。2 名 LGV 患者同时合并直肠淋病感染。LGV（n=5，71％）和非 LGV（n=98，77％）CT 血清型的参与者中 HIV 合并感染很常见（P=0.66）。
在本研究中，尼日利亚 MSM 中 LGV 少见但存在。对 CT 的 L 血清型进行持续筛查，或对高度怀疑患有 LGV 的病例进行推定治疗，可能会改善患者的预后并减少传播。
