Lymphogranuloma Venereum in Men Screened for Pharyngeal and Rectal Infection, Germany

The Study

Conclusions

Acknowledgments

References

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Table 1

Table 2

Suggested Citation

Karin Haar

, Sandra Dudareva-Vizule, Hilmar Wisplinghoff, Fabian Wisplinghoff, Andrea Sailer, Klaus Jansen, Birgit Henrich, and Ulrich Marcus

Author affiliations: Author affiliations: Robert Koch-Institute, Berlin, Germany (K. Haar, S. Dudareva-Vizule, A. Sailer, K. Jansen, U. Marcus); European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden (S. Dudareva-Vizule); University of Cologne, Cologne, Germany (H. Wisplinghoff); Laboratoriumsmedizin Köln–Dres. med. Wisplinghoff and Colleagues, Cologne (H. Wisplinghoff, F. Wisplinghoff); Heinrich-Heine-University, Duesseldorf, Germany (B. Henrich)

Abstract

To determine prevalence of lymphogranuloma venereum among men who have sex with men in Germany, we conducted a multicenter study during 2009–2010 and found high rates of rectal and pharyngeal infection in men positive for the causative agent, Chlamydia trachomatis. Many infections were asymptomatic. An adjusted C. trachomatis screening policy is justified in Germany.

Lymphogranuloma venereum (LGV) is a sexually transmitted disease caused by infection with Chlamydia trachomatis bacteria, genotypes L1–L3. An outbreak of proctitis cases caused by C. trachomatis genotype L2 in men who have sex with men (MSM) became apparent in the Netherlands in 2003; subsequently, awareness of this disease increased throughout Europe (1).
In the United Kingdom and the United States, guidelines recommend rectal C. trachomatis screening for MSM (2). In Germany, no screening recommendations for asymptomatic MSM exist, and nationally, no C. trachomatis prevalence data are available. We investigated the prevalence of pharyngeal and rectal C. trachomatis infection and LGV among MSM in Germany.

The Study

We conducted a prospective, multicenter study during December 1, 2009–December 31, 2010, by recruiting a convenience sample of MSM at sentinel sites for sexually transmitted infections throughout Germany. Inclusion criteria were being MSM, having >1 male sexual partner within the previous 6 months, and agreeing to provide a rectal and/or pharyngeal swab specimen. To measure factors associated with HIV status, enrollment at sites providing HIV care was enhanced.
Rectal and pharyngeal specimens were collected according to standardized protocols; urine testing or collection of urethral swabs was optional. All specimens were sent to a privately owned laboratory (Laboratoriumsmedizin Koeln, Cologne, Germany), and tested for C. trachomatis by using the APTIMA Combo 2 Assay (GenProbe Inc., San Diego, CA, USA), based on RNA amplification. Specimens positive for C. trachomatis were sent to the Institute of Medical Microbiology and Hospital Hygiene of Heinrich-Heine University in Duesseldorf, Germany, for L genotyping, based on a DNA test (3). Persons who had a sample positive for LGV genotype L were defined as LGV-positive; those positive for other genotypes were defined as LGV-negative.
Data on sexual history, behavior, and symptoms were collected from participants through a self-administered questionnaire. Information on HIV status was self-reported or obtained from primary care providers. Results were assessed with 95% CIs, and significance level was set at 0.05. The study protocol was approved by the ethical review committee of Charité University Hospital, Berlin. Data were anonymized, participation was voluntary, and no financial incentives were provided.