CONHIV14 - HIV-related Infections, Co-infections and Cancers, etc. – Part three - page 8

Background
Materials and Methods
Results
Gerrit Mohrmann
1
, Christian Noah
1
, Michael Sabranski
2
, Hany Sahly
1
,
Hans-Jürgen Stellbrink
2
1
Labor Lademannbogen MVZ GmbH, Hamburg
2
Infektionsmedizinisches Centrum Hamburg (ICH)
Lymphogranuloma venereum (LGV) is a sexually transmitted
infection (STI) caused by Chlamydia trachomatis (CT) genotype L
(L1, L2 and L3). Recent outbreaks of LGV in Europe and North
America affected mainly men who have sex with men (MSM).
Infections with CT serotypes D-K are mostly associated with mild
symptoms or may be clinically silent. However infections with L
genotypes are more invasive and induce anogenital ulcer or inguinal
lymphadenopathy. In addition, LGV may be associated with
increased risk of STI transmission.
Between 2003 and 2013, anal or genital CT infections were
diagnosed in 471 symptomatic patients attending the Infectious
Diseases Center Hamburg (ICH). CT DNA was detected by PCR. CT
genotyping of positive samples was performed by sequence
analyses of ompA PCR products (samples between 2003 and 2010,
Fig.1a). Samples between 2012 and 2013 were analyzed by
genotype L specific real-time PCR (Fig.1b).
Conclusions
Fig.1a
Sequence analysis of ompA
PCR products
Fig.1b
Genotype L specific real-time
PCR
In total, 221 LGV patients were identified (3 in 2003; 11 in 2004; 26 in
2005; 33 in 2006; 24 in 2007; 16 in 2008; 18 in 2009; 15 in 2010; 17
in 2011; 26 in 2012 and 32 in 2013). 198 of 221 (89,6%) patients with
LGV were HIV-infected (Fig.2); 10 of 221 (4,5%) were HIV negative,
and the HIV status unknown in 13 (5,9%).
Of 283 CT positive patients with anorectal symptoms, genotype L
was detected in 205 (72%), while non-L genotypes (D-K) were found
in 78 (28%). In contrast genotype L was found in only 6% of patients
with genital symptoms (11/177), whereas 94% (166/177) were
infected with non-L genotypes only (Fig. 4 and 5).
The majority of LGV positive patients (204/221; 92%) had anorectal
symptoms (bloody proctitis, rectal pain, purulent or mucous
discharge, tenesms, constipation), compared to 17/221 (8%) who
presented with genital symptoms as urethritis, genital ulcer or
inguinal lymphadenopathy (Fig.3).
Fig.2
HIV Status of 221 LGV positive patients
198 (89,6%)
13 (5,9%)
10 (4,5%)
HIV positive HIV negative HIV status unknown
Fig.4
Distribution of CT genotypes
in 283 patients with anorectal
symptoms
Fig.3
Clinical symptoms of 221
LGV positive patients
204 (92%)
17 (8%)
Anorectal
symptoms
Genital
symptoms
205 (72%)
78 (28%)
CT genotype L
CT non-L
genotypes
The epidemic of LGV among predominantly HIV+ MSM is ongoing.
LGV might be underdiagnosed, especially in patients with anorectal
symptoms. Infections with CT serotypes D-K are more often
associated with urogenital symptoms or asymptomatic infection,
whereas LGV genotypes are found most frequently in patients with
rectal/intestinal symptoms. Anorectal CT infections in MSM should
be further characterized by genotyping for LGV, as for LGV three
weeks of doxycycline treatment are recommended. CT genotypes D-
K generally require shorter antibiotic treatment. If CT genotyping is
not available, the duration of treatment should be prolonged to three
weeks empirically for CT positive patients with anorectal or intestinal
symptoms.
Fig.6
Genotype specific antibiotic treatment of Chlamydia trachomatis
infections (CDC MMWR 2006, Vol. 55, McLean 2007, Kapoor 2008,
STI/STD: Beratung, Diagnostik und Therapie, 1. Edition: 27.03.2013
CT L genotypes
Recommended Regimen
Doxycycline: 2x100 mg/day
for at least 3 weeks
Alternative Regimen
Erythromycin base*:4x500 mg/day
for at least 3 weeks
Azithromycin*:
1 g/week
for at least 3 weeks
CT non-L genotypes
Recommended Regimen
Doxycycline: 2x100 mg/day
for at least 1-2 weeks
Alternative Regimen
Erythromycin base*: 4x500 mg/day
for at least 1-2 weeks
Azithromycin*: 1 g/week
for at least 1-2 weeks
*Limited data
Fig.5
Distribution of CT genotypes
in 177 patients with genital symptoms
Genotype L
11 (6%)
Non-L genotypes
166 (94%)
Ongoing epidemic of Lymphogranuloma venereum
(LGV) in HIV positive men who have sex with men
(MSM): How symptoms should guide treatment
1,2,3,4,5,6,7 9,10,11,12
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