Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
J Microbiol Immunol Infect. 2023 Apr;56(2):408-415. doi: 10.1016/j.jmii.2023.01.007. Epub 2023 Jan 14.
The prevalence of rectal chlamydia among men who have sex with men (MSM) without human deficiency virus infection (non-HIV) remains uncertain in Taiwan, and rectal lymphogranuloma venereum (LGV) among MSM has never been reported in the Far East.
From January 2020 to April 2022, MSM coming for anonymous voluntary counseling and testing, for pre-exposure prophylaxis, and for antiretroviral therapy were enrolled. All participants submitted his fecal samples and completed a QR-code questionnaire. Medical records of those who took regular medical visits for HIV were recorded. Multiplex polymerase chain reaction (PCR) was performed for all fecal samples, and ompA gene sequencing was therefore performed for each Chlamydia-positive fecal sample.
Among 341 MSM during 2020-2022 in southern Taiwan, 21 (6.2%) had rectal chlamydia infection. Risk factors of rectal chlamydia included co-infection with rectal gonorrhea (adjusted odds ratio [AOR] 6.78, 95% confidence interval [CI] 1.44-31.91, P = 0.015) and multiple sexual partners (AOR 1.373, 95% CI 1.002-1.882, P = 0.048). Further ompA gene sequencing from 19 Chlamydia-positive fecal samples revealed that the prevalent genotypes or genovariants were Da (26.3%) and L2b (26.3%), followed by B (21.1%), J (14.3%), and G (9.5%). All cases of rectal LGV genovariant L2b presented as acute proctitis with diarrhea, anal pain, or discharge and were treated successfully with prolonged treatment of doxycycline.
Rectal gonorrhea and multiple sexual partners are risk factors for rectal chlamydia. Clinicians in Taiwan should be aware of the emerging threat of rectal LGV among MSM with acute proctitis.
在台湾，未感染人类免疫缺陷病毒（HIV）的男男性行为者（MSM）中直肠衣原体的流行率尚不确定，远东地区也从未报告过 MSM 的直肠淋球菌肉芽肿（LGV）。
2020 年 1 月至 2022 年 4 月，招募前来匿名自愿咨询和检测、接受暴露前预防和接受抗逆转录病毒治疗的 MSM。所有参与者均提交粪便样本并完成二维码问卷。记录定期接受 HIV 医疗随访的患者的病历。对所有粪便样本进行多重聚合酶链反应（PCR），因此对每个衣原体阳性粪便样本进行 ompA 基因测序。
2020-2022 年间，在台湾南部的 341 名 MSM 中，有 21 名（6.2%）患有直肠衣原体感染。直肠衣原体感染的危险因素包括合并直肠淋病感染（调整优势比 [AOR] 6.78，95%置信区间 [CI] 1.44-31.91，P=0.015）和多个性伴侣（AOR 1.373，95%CI 1.002-1.882，P=0.048）。对 19 份衣原体阳性粪便样本进一步进行 ompA 基因测序，结果显示主要流行基因型或基因变体为 Da（26.3%）和 L2b（26.3%），其次为 B（21.1%）、J（14.3%）和 G（9.5%）。所有直肠 LGV 基因变体 L2b 型病例均表现为急性直肠炎，伴有腹泻、肛门疼痛或分泌物，并通过延长多西环素治疗成功治愈。
直肠淋病和多个性伴侣是直肠衣原体感染的危险因素。台湾的临床医生应该意识到急性直肠炎的 MSM 中直肠 LGV 的新威胁。
