调查自 2016 年以来英国男男性行为人群中淋巴肉芽肿诊断病例的下降情况：监测数据分析。

Investigating the decline in Lymphogranuloma venereum diagnoses in men who have sex with men in the United Kingdom since 2016: an analysis of surveillance data.

机构信息

National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK; and Corresponding author. Email:

National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.

出版信息

Sex Health. 2020 Aug;17(4):344-351. doi: 10.1071/SH20001.

DOI:10.1071/SH20001

PMID:32762828

Abstract

UNLABELLED

Background Following an upward trajectory in Lymphogranuloma venereum (LGV) diagnoses in the UK from 2004 to 2016, with annual diagnoses increasing from 28 to 904, diagnoses fell to 641 in 2017; this was inconsistent with the upward trend in other bacterial sexually transmissible infections (STIs) between 2016 and 2017. An analysis of surveillance data from multiple sources to investigate the possible factors contributing to this decline in LGV was performed.

METHODS

LGV tests and diagnoses in the UK from 2004 to 2018 were captured through laboratory data from the LGV Reference Laboratories and laboratories conducting in-house LGV testing. These data and clinical diagnoses data from England were analysed alongside the national management guidelines issued over the course of the epidemic.

RESULTS

LGV diagnoses increased between 2004 and 2015 and then decreased between 2016 and 2018. LGV testing increased from 2010 to 2018 (2690-10850). Test positivity halved between 2015 (14.8%, 929-6272) and 2018 (7.3%, 791-10850). Peaks in LGV testing and diagnoses appeared to coincide with the publication of national LGV management guidelines and changes to clinical practice. The proportion of LGV diagnoses among HIV-positive men who have sex with men (MSM) fell between 2013 and 2018 (74-48%).

CONCLUSIONS

The fall in diagnoses and positivity were likely due to increasing earlier clinical diagnosis and treatment. Changes to the national management guidelines, the clinical policy and practice of some larger clinics and potentially changes to the guidelines for the treatment of chlamydia broadened the scope of testing and increased testing in asymptomatic patients which, in combination, likely had a positive effect on the control of LGV infection.

摘要

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背景自 2004 年至 2016 年，英国的淋菌肉芽肿（LGV）诊断呈上升趋势，每年的诊断数从 28 例增加到 904 例，而 2017 年则降至 641 例；这与 2016 年至 2017 年期间其他细菌性性传播感染（STI）的上升趋势不一致。对来自多个来源的监测数据进行了分析，以调查导致 LGV 下降的可能因素。

方法英国 2004 年至 2018 年的 LGV 检测和诊断通过 LGV 参考实验室和进行内部 LGV 检测的实验室的实验室数据进行捕获。对英格兰的这些数据和临床诊断数据进行了分析，并与整个流行期间发布的国家管理指南进行了对比。

结果 LGV 诊断在 2004 年至 2015 年之间增加，然后在 2016 年至 2018 年之间减少。LGV 检测从 2010 年增加到 2018 年（2690-10850）。2015 年（14.8%，929-6272）和 2018 年（7.3%，791-10850）之间，检测阳性率减半。LGV 检测和诊断的高峰似乎与国家 LGV 管理指南的发布以及临床实践的变化相吻合。2013 年至 2018 年，HIV 阳性男男性行为者（MSM）中的 LGV 诊断比例下降（74%-48%）。

结论诊断和阳性率的下降可能是由于更早的临床诊断和治疗的增加。国家管理指南的变化、一些较大诊所的临床政策和实践以及治疗衣原体的指南的潜在变化扩大了检测范围并增加了无症状患者的检测，这两者相结合，可能对控制 LGV 感染产生了积极影响。