在欧洲男男性行为者中，淋菌性肉芽肿的大量漏诊：一项多中心监测研究的初步结果。
Substantial underdiagnosis of lymphogranuloma venereum in men who have sex with men in Europe: preliminary findings from a multicentre surveillance pilot.
机构信息
National Infection Service, Public Health England, London, UK
National Infection Service, Public Health England, London, UK.
出版信息
Sex Transm Infect. 2020 Mar;96(2):137-142. doi: 10.1136/sextrans-2019-053972. Epub 2019 Jun 23.
OBJECTIVES
Understanding the public health impact of lymphogranuloma venereum (LGV) in Europe is hampered by inadequate diagnostics and surveillance systems in many European countries. We developed and piloted LGV surveillance in three European countries without existing systems and performed a preliminary investigation of LGV epidemiology, where little evidence currently exists.
METHODS
We recruited STI or dermatovenereology clinics and associated laboratories serving men who have sex with men (MSM) in Austria, Croatia and Slovenia, using the UK for comparison. We undertook centralised LGV testing of (CT)-positive rectal swabs collected between October 2016 and May 2017 from MSM attending these clinics. Stored specimens from Austria (2015-2016) and Croatia (2014) were also tested. Clinical and sociodemographic data were collected using a standardised proforma. The gene of LGV-positive specimens was sequenced.
RESULTS
In total, 500 specimens from CT-positive MSM were tested, and LGV positivity was 25.6% (128/500; 95% CI 22.0% to 29.6%) overall, and 47.6% (79/166; 40.1% to 55.2%) in Austria, 20.0% (3/15; 7.1% to 45.2%) in Croatia, 16.7% (1/6; 3.0% to 56.4%) in Slovenia and 14.4% (45/313; 10.9% to 18.7 %) in the UK. Proformas were completed for cases in Croatia, Slovenia and in the UK; proformas could not be completed for Austrian cases, but limited data were available from line listings. Where recorded, 83.9% (78/93) of LGV-CT cases were HIV-positive compared with 65.4% (149/228) of non-LGV-CT cases; MSM with LGV-CT were more likely to have proctitis (Austria, 91.8% vs 40.5%, p<0.001; Croatia, 100% vs 25%, p=0.04; UK, 52.4% vs 11.7%, p<0.001) than those with non-LGV-CT. Six different sequences were identified, including three new variants; the L2 sequence predominated (58.6%, 51/87).
CONCLUSIONS
LGV is substantially underdiagnosed in MSM across Europe. Unified efforts are needed to overcome barriers to testing, establish effective surveillance, and optimise diagnosis, treatment and prevention.
目的
在许多欧洲国家，由于诊断和监测系统不完善，人们对淋球菌病（LGV）的公共卫生影响了解不足。我们在没有现有系统的三个欧洲国家开发并试行 LGV 监测，并对 LGV 流行病学进行了初步调查，目前这方面的证据很少。
方法
我们在奥地利、克罗地亚和斯洛文尼亚招募了性传播感染或皮肤性病科诊所及其为男男性行为者（MSM）服务的相关实验室，并以英国作为比较。我们对 2016 年 10 月至 2017 年 5 月期间在这些诊所就诊的 MSM 进行了集中 LGV 检测（CT）阳性直肠拭子。还对奥地利（2015-2016 年）和克罗地亚（2014 年）的储存标本进行了检测。使用标准化表格收集临床和社会人口统计学数据。对 LGV 阳性标本的 基因进行了测序。
结果
总共对 500 份 CT 阳性 MSM 的标本进行了检测，LGV 阳性率为 25.6%（500 份中的 128 份；95%CI 22.0%至 29.6%），奥地利为 47.6%（166 份中的 79 份；40.1%至 55.2%），克罗地亚为 20.0%（15 份中的 3 份；7.1%至 45.2%），斯洛文尼亚为 16.7%（6 份中的 1 份；3.0%至 56.4%），英国为 14.4%（313 份中的 45 份；10.9%至 18.7%）。完成了克罗地亚、斯洛文尼亚和英国病例的表格，但奥地利病例的表格无法完成，但从列表中可以获得有限的数据。记录到的 83.9%（78/93）的 LGV-CT 病例为 HIV 阳性，而 65.4%（149/228）的非 LGV-CT 病例为 HIV 阳性；LGV-CT 的 MSM 更有可能患有直肠炎（奥地利，91.8% vs 40.5%，p<0.001；克罗地亚，100% vs 25%，p=0.04；英国，52.4% vs 11.7%，p<0.001）。确定了六个不同的 序列，包括三个新变体；L2 序列占主导地位（58.6%，51/87）。
结论
在整个欧洲，淋球菌病在 MSM 中的诊断严重不足。需要做出统一的努力来克服检测障碍，建立有效的监测，并优化诊断、治疗和预防。
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