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1.
Euro Surveill ; 26(18)2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33960288

RESUMEN

Despite social distancing measures implemented in Madrid to prevent the propagation of SARS-CoV-2, a significant increase (57.1%; 28.5 to 38.5 cases/month) in cases of lymphogranuloma venereum was detected during the COVID-19 pandemic. This unusual scenario might have accelerated a shift in Chlamydia trachomatis (CT) epidemiology towards a higher proportion of L genotypes compared with non-L genotypes in CT-positive samples. Our data underscore the importance of surveillance of sexually transmitted infections during the pandemic, in particular among vulnerable populations.


Asunto(s)
Linfogranuloma Venéreo , Chlamydia trachomatis/genética , Homosexualidad Masculina , Humanos , Linfogranuloma Venéreo/diagnóstico , Linfogranuloma Venéreo/epidemiología , Masculino , Pandemias , España/epidemiología
2.
BMJ Case Rep ; 14(4)2021 Apr 14.
Artículo en Inglés | MEDLINE | ID: mdl-33853816

RESUMEN

A 49-year-old man presented with a 1-week history of abdominal pain, distension, diarrhoea and fatigue. CT of the abdomen and pelvis revealed peritonitis with no identifiable cause. Diagnostic laparoscopy was performed, which excluded gastrointestinal perforation. Peritoneal fluid tested positive for Chlamydia trachomatis and rectal swabs were positive for C. trachomatis serovars consistent with lymphogranuloma venereum (LGV). Additional blood tests also revealed a diagnosis of syphilis. This is a rare documented case of LGV peritonitis in a male without associated immunodeficiency. The patient recovered well following laparoscopic washout and a course of appropriate antibiotics.


Asunto(s)
Linfogranuloma Venéreo , Peritonitis , Antibacterianos/uso terapéutico , Chlamydia trachomatis , Homosexualidad Masculina , Humanos , Linfogranuloma Venéreo/complicaciones , Linfogranuloma Venéreo/diagnóstico , Linfogranuloma Venéreo/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Peritonitis/diagnóstico , Peritonitis/tratamiento farmacológico
3.
Ned Tijdschr Geneeskd ; 1642020 11 19.
Artículo en Holandés | MEDLINE | ID: mdl-33332026

RESUMEN

Lymphogranuloma venereum (LGV) is an invasive sexually transmitted infection caused by Chlamydia trachomatis genotypes L1, L2 and L3. Until recently, LGV was rarely seen in developed countries. However, an outbreak of LGV infections in Europe amongst men who have sex with men (MSM) has been reported in the past decades. Diagnosing LGV can be challenging since there is no pathognomic clinical presentation. Most patients are diagnosed with LGV by Community Healthcare Services and general practitioners. Recent data show that a significant diagnostic delay can occur when patients present in a hospital with symptoms due to LGV infection. This can result in unnecessary additional diagnostic procedures and a subsequent diagnostic delay. In order to create more awareness, we describe 3 cases in our hospital with an initially unrecognized LGV infection. We also discuss the epidemiology, clinical manifestations, diagnostic process and treatment of LGV infection.


Asunto(s)
Homosexualidad Masculina , Linfogranuloma Venéreo/diagnóstico , Adulto , Antibacterianos/uso terapéutico , Chlamydia trachomatis/genética , Diagnóstico Tardío , Doxiciclina/uso terapéutico , Genotipo , Humanos , Linfogranuloma Venéreo/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Atención Secundaria de Salud
4.
Actas dermo-sifiliogr. (Ed. impr.) ; 111(9): 743-751, nov. 2020. ilus, tab
Artículo en Español | IBECS | ID: ibc-201003

RESUMEN

El linfogranuloma venéreo (LGV) es una enfermedad emergente en hombres que tienen sexo con hombres (HsH), con una incidencia en España de 1,15 casos por 100.000 habitantes en el año 2017. Suele cursar como una proctitis severa que puede ocasionar abscesos, fístulas y estenosis anal. Raramente se manifiesta con úlceras genitales o adenopatías inflamatorias inguinales. El objetivo de este trabajo fue describir una serie de pacientes con LGV de un hospital público de Andalucía. MATERIAL Y MÉTODOS: Estudio observacional descriptivo de una cohorte retrospectiva de casos diagnosticados de LGV. Se recogieron variables epidemiológicas, clínicas, microbiológicas, de tratamiento, así como los hábitos sexuales de los pacientes. RESULTADOS: Se seleccionaron los 17 casos diagnosticados entre octubre de 2016 y mayo de 2019 en HsH, 12 de ellos positivos para el VIH. Trece pacientes tuvieron una proctitis muy sintomática con ulceraciones en el canal anal y el recto. En 4 pacientes el LGV se manifestó en la forma genital o inguinal. Se identificaron prácticas sexuales de alto riesgo: un número elevado de parejas y sexo anal receptivo anónimo sin protección, búsqueda de sexo por Internet y sexo en grupo o fuera de nuestra comunidad. La Chlamydia trachomatis L2 se identificó en todos los casos, con una buena respuesta a la doxiciclina oral. Dos pacientes con la forma clásica necesitaron ciclos más prolongados de tratamiento y en 3 de ellos fue necesario tratamiento quirúrgico. CONCLUSIONES: Ante una proctitis sintomática en HsH con prácticas sexuales de alto riesgo debemos tomar muestras de exudado para identificar los serovares de LGV. Las úlceras genitales y los bubones inguinales son también muy sugerentes de la infección. La sospecha de LGV y el tratamiento precoz son fundamentales para prevenir las complicaciones y la transmisión de la enfermedad


Lymphogranuloma venereum (LGV) is an emerging disease in men who have sex with men (MSM): the incidence was 1.15 cases per 100,000 population in Spain in 2017. Patients with LGV characteristically have severe proctitis that can cause abscesses, fistulas, and anal stenosis. Genital ulcers and inflammatory inguinal adenopathy may occasionally be present. The aim of this study was to describe a series of patients with LGV treated in a public health service hospital in Andalusia, Spain. MATERIAL AND METHODS: Retrospective, observational description of a series of patients diagnosed with LGV. We gathered epidemiologic, clinical, microbiologic, and treatment data. Patients' sexual behaviors were also noted. RESULTS: We found 17 cases of LGV diagnosed in MSM between October 2016 and May 2019. Twelve of the patients were also infected with the human immunodeficiency virus, and 13 had severe proctitis with ulcers in the anal canal and rectum. Four patients had genital or inguinal manifestations. The following high-risk sexual behaviors were on record: a high number of sexual partners, receptive anal sex with strangers and without a condom, seeking sexual partners online, participation in group sex, and sex with partners from outside Andalusia. Chlamydia trachomatis serovar L2 was identified in all cases, and the infection responded well to oral doxycycline. Two patients with the most characteristic form of LGV required longer treatment cycles. Three required surgery. CONCLUSIONS: When symptomatic proctitis is found in MSM who engage in high-risk sex, the LGV exudate should be sampled and the C trachomatis serovar identified. Genital ulcers or inguinal buboes are also highly suggestive of LGV. Clinical suspicion and early treatment are the keys to preventing complications and disease transmissios


Asunto(s)
Humanos , Masculino , Adulto , Linfogranuloma Venéreo/epidemiología , Linfogranuloma Venéreo/diagnóstico , Hospitales Públicos/estadística & datos numéricos , Estudios de Cohortes , Linfogranuloma Venéreo/microbiología , España/epidemiología , Proctitis/complicaciones , Estudios Retrospectivos , Canal Anal/patología , Chlamydia trachomatis/aislamiento & purificación , Doxiciclina/uso terapéutico , Factores de Riesgo , Encuestas y Cuestionarios , Homosexualidad Masculina/estadística & datos numéricos
9.
Euro Surveill ; 25(14)2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32290900

RESUMEN

IntroductionLymphogranuloma venereum (LGV), an invasive form of Chlamydia trachomatis infection, has been reported among (mainly HIV-positive) men who have sex with men (MSM) since 2003. In the Netherlands, LGV testing recommendations changed from selective to universal testing in 2015. Changes in tested populations could have led to incomparable LGV positivity rates over time.AimWe investigated LGV trends among MSM attending Centres for Sexual Health using surveillance data between 2011 and 2017.MethodsLGV positivity was calculated among MSM tested for rectal Chlamydia infection and MSM tested specifically for LGV. With multivariable logistic regression analysis, the association between years and LGV was adjusted for testing indicators and determinants.ResultsWe included 224,194 consultations. LGV increased from 86 in 2011 to 270 in 2017. Among LGV-positives, proportions of HIV-negative and asymptomatic MSM increased from 17.4% to 45.6% and from 31.4% to 49.3%, respectively, between 2011 and 2017. Among MSM tested for rectal chlamydia, LGV positivity increased from 0.12% to 0.33% among HIV-negatives and remained stable around 2.5% among HIV-positives. Among LGV-tested MSM, LGV positivity increased from 2.1% to 5.7% among HIV-negatives and from 15.1% to 22.1% among HIV-positives. Multivariable models showed increased odds ratios and significant positive associations between years and LGV.ConclusionsAlthough increased testing and changes in LGV incidence are difficult to disentangle, we found increasing LGV trends, especially when corrected for confounding. LGV was increasingly attributed to HIV-negative and asymptomatic MSM, among whom testing was previously limited. This stresses the importance of universal testing and continuous surveillance.


Asunto(s)
Seronegatividad para VIH , Homosexualidad Masculina/psicología , Linfogranuloma Venéreo/epidemiología , Adulto , Infecciones Asintomáticas , Infecciones por VIH/epidemiología , Humanos , Incidencia , Linfogranuloma Venéreo/diagnóstico , Masculino , Países Bajos/epidemiología , Vigilancia de Guardia
10.
Hautarzt ; 71(4): 275-283, 2020 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-32025745

RESUMEN

BACKGROUND: Sexually transmitted infections (STIs) in the anorectal region are disproportionally detected in risk populations such as men who have sex with men (MSM). However, due to changes in sexual behaviour they are increasingly diagnosed in heterosexual individuals. Due to the recent implementation of oral HIV pre-exposure prophylaxis together with lack of condom use, a further rise in STIs is expected. OBJECTIVES: This review addresses epidemiology, clinical picture, diagnostic pitfalls and current therapy guidelines of "classical" bacterial STIs involving the anorectum. CONCLUSIONS: STI manifestations in the anal region are frequently nonspecific or asymptomatic so that the diagnosis may be missed. In an endoscopic examination of the rectum, they can even mimic inflammatory bowel disease or malignancy. Therefore, knowledge of possible symptoms of bacterial STIs in this area is helpful for early diagnosis. Coinfections with other STIs are common and should prompt a search of other pathogens including HIV and hepatitis B/C.


Asunto(s)
Enfermedades del Ano/diagnóstico , Coinfección/diagnóstico , Enfermedades del Recto/diagnóstico , Conducta Sexual , Enfermedades de Transmisión Sexual , Sexo Inseguro , Enfermedades del Ano/epidemiología , Enfermedades del Ano/terapia , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/terapia , Coinfección/epidemiología , Femenino , Gonorrea/diagnóstico , Gonorrea/epidemiología , Gonorrea/terapia , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Heterosexualidad , Homosexualidad Masculina , Humanos , Linfogranuloma Venéreo/diagnóstico , Linfogranuloma Venéreo/epidemiología , Linfogranuloma Venéreo/terapia , Masculino , Enfermedades del Recto/epidemiología , Enfermedades del Recto/terapia , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/terapia , Sífilis/diagnóstico , Sífilis/epidemiología , Sífilis/terapia
12.
Sex Transm Infect ; 96(2): 137-142, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31235527

RESUMEN

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 Chlamydia trachomatis (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 ompA 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 ompA sequences were identified, including three new variants; the L2 ompA 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.


Asunto(s)
Linfogranuloma Venéreo/epidemiología , Proctitis/epidemiología , Minorías Sexuales y de Género/estadística & datos numéricos , Adulto , Austria/epidemiología , Proteínas de la Membrana Bacteriana Externa/genética , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/microbiología , Chlamydia trachomatis/genética , Coinfección/epidemiología , Croacia/epidemiología , Monitoreo Epidemiológico , Europa (Continente)/epidemiología , Gonorrea/epidemiología , Infecciones por VIH/epidemiología , Humanos , Linfogranuloma Venéreo/diagnóstico , Linfogranuloma Venéreo/microbiología , Masculino , Persona de Mediana Edad , Proyectos Piloto , Proctitis/microbiología , Reacción en Cadena en Tiempo Real de la Polimerasa , Recto/microbiología , Eslovenia/epidemiología , Reino Unido/epidemiología
14.
Emerg Infect Dis ; 25(11): 2112-2114, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31625852

RESUMEN

Orolabial lymphogranuloma venereum was diagnosed for a man in Michigan, USA, who had sex with men, some infected with HIV. High index of suspicion for lymphogranuloma venereum led to accurate diagnosis, successful therapy, and description of an L2b variant with a unique genetic mutation.


Asunto(s)
Enfermedades de los Labios/diagnóstico , Enfermedades de los Labios/microbiología , Linfogranuloma Venéreo/diagnóstico , Linfogranuloma Venéreo/microbiología , Adulto , Coinfección , Infecciones por VIH , Homosexualidad Masculina , Humanos , Linfogranuloma Venéreo/transmisión , Masculino , Úlcera/microbiología
15.
J Eur Acad Dermatol Venereol ; 33(10): 1821-1828, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31243838

RESUMEN

New or important issues in this updated version of the 2013 European guideline on the management of lymphogranuloma venereum (LGV): EPIDEMIOLOGY: Lymphogranuloma venereum continues to be endemic among European men who have sex with men (MSM) since 2003. Lymphogranuloma venereum infections in heterosexuals are extremely rare in Europe, and there is no evidence of transmission of LGV in the European heterosexual population. AETIOLOGY AND TRANSMISSION: Chlamydia trachomatis serovars/genovars L2b and L2 are the causative strains in the majority of cases in Europe. CLINICAL FEATURES: Among MSM, about 25% of the anorectal LGV infections are asymptomatic. Genital infections among MSM are rare; the ratio of genital vs. anorectal LGV infections is 1 in 15. DIAGNOSIS: To diagnose LGV, a sample tested C. trachomatis positive with a commercial nucleic acid amplification test (NAAT) platform should be confirmed with an LGV discriminatory NAAT. TREATMENT: Doxycycline 100 mg twice a day orally for 21 days is the recommended treatment for LGV. This same treatment is recommended also in asymptomatic patients and contacts of LGV patients. If another regimen is used, a test of cure (TOC) must be performed.


Asunto(s)
Antibacterianos/uso terapéutico , Linfogranuloma Venéreo/diagnóstico , Linfogranuloma Venéreo/tratamiento farmacológico , Linfogranuloma Venéreo/terapia , Trazado de Contacto , Notificación de Enfermedades , Europa (Continente) , Humanos , Linfogranuloma Venéreo/etiología , Educación del Paciente como Asunto
17.
Enferm Infecc Microbiol Clin ; 37(8): 525-534, 2019 Oct.
Artículo en Inglés, Español | MEDLINE | ID: mdl-30878312

RESUMEN

Sexually transmitted infections caused by Chlamydia trachomatis, including lymphogranuloma venereum and Mycoplasma genitalium have increased in last decade. This epidemiological scenario presents new challenges in order to improve and strengthen our control and prevention strategies. The routine clinical diagnosis of urethritis and cervicitis must be combined with the active search for the causal agent in men with symptoms of dysuria or proctitis, and in women with pelvic inflammatory disease. We should also include sexually transmitted infections screening in asymptomatic patients with sexual risk behaviours or sexual contact with patients diagnosed with an sexually transmitted infection. The microbiological diagnosis must be based on molecular techniques capable of detecting Chlamydia trachomatis (discriminating between L genotypes associated with lymphogranuloma venereum and other genotypes) and Mycoplasma genitalium (ideally including the identification of macrolide-resistant strains). A faster and specific diagnosis will allow for a targeted treatment with a suitable antibiotic regimen. We also recommend including contact tracing of sexual partners and, occasionally, a cure test. Finally, sexually transmitted infection screening must be widely implemented in those population groups with a high prevalence of sexually transmitted infections.


Asunto(s)
Infecciones por Chlamydia , Chlamydia trachomatis , Linfogranuloma Venéreo , Infecciones por Mycoplasma , Mycoplasma genitalium , Enfermedades de Transmisión Sexual , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/terapia , Femenino , Humanos , Linfogranuloma Venéreo/diagnóstico , Linfogranuloma Venéreo/epidemiología , Linfogranuloma Venéreo/terapia , Masculino , Infecciones por Mycoplasma/diagnóstico , Infecciones por Mycoplasma/epidemiología , Infecciones por Mycoplasma/terapia , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/terapia
18.
Int J STD AIDS ; 30(5): 515-518, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30714874

RESUMEN

An epidemic of lymphogranuloma venereum among men who have sex with men (MSM) has persisted in Australia for over a decade and virtually all diagnoses are made from rectal samples. We discuss two cases of human immunodeficiency virus-negative MSM who presented with a penile ulcer. The diagnosis can be made by ensuring a swab of any such ulcer is tested for Chlamydia trachomatis.


Asunto(s)
Chlamydia trachomatis/aislamiento & purificación , Homosexualidad Masculina , Linfogranuloma Venéreo/diagnóstico , Adulto , Canal Anal/microbiología , Antibacterianos/uso terapéutico , Doxiciclina/uso terapéutico , Seronegatividad para VIH , Humanos , Linfogranuloma Venéreo/tratamiento farmacológico , Linfogranuloma Venéreo/microbiología , Masculino , Resultado del Tratamiento , Úlcera/diagnóstico , Úlcera/tratamiento farmacológico , Úlcera/microbiología
19.
Euro Surveill ; 24(5)2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30722812

RESUMEN

Diagnoses of bacterial sexually transmitted infections (STI) have been increasing in France since their resurgence in the late 1990s. This article presents recent epidemiological trends until 2016 and the patients' characteristics. STI surveillance relies on sentinel networks: a clinician-based network RésIST (clinical, biological and behavioural data for early syphilis and gonorrhoea), the lymphogranuloma venereum (LGV) network (clinical, biological and behavioural data for rectal LGV, and the laboratory networks Rénachla and Rénago (demographic and biological data for chlamydial infections and gonorrhoea, respectively). Here we describe trends between 2014 and 2016, using data from diagnostic centres which participated regularly during the study period. The number of early syphilis, gonorrhoea and LGV diagnoses increased between 2014 and 2016, particularly in men who have sex with men. An increase in syphilis and gonorrhoea cases was also observed in heterosexuals. Nevertheless, we observed a drop in 2016 for syphilis and chlamydial infections after two decades of increases. Under-reporting and shortage of benzathine penicillin in 2016 may explain this latest evolution. Regular screening of patients and partners, followed by prompt treatment, remains essential to interrupt STI transmission in a context where human immunodeficiency virus (HIV) prevention has expanded towards biomedical prophylaxis.


Asunto(s)
Heterosexualidad/estadística & datos numéricos , Homosexualidad Masculina/estadística & datos numéricos , Tamizaje Masivo/métodos , Vigilancia de la Población/métodos , Enfermedades Bacterianas de Transmisión Sexual/epidemiología , Adulto , Femenino , Francia/epidemiología , Gonorrea/diagnóstico , Gonorrea/epidemiología , Humanos , Linfogranuloma Venéreo/diagnóstico , Linfogranuloma Venéreo/epidemiología , Masculino , Vigilancia de Guardia , Enfermedades Bacterianas de Transmisión Sexual/diagnóstico , Sífilis/diagnóstico , Sífilis/epidemiología
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