Ano-rectal lymphogranuloma venereum: 22 cases reported in a Sexually Transmited Infections center in Paris

In January 2004 the European Surveillance of Sexually Transmitted Infections Network (ESSTI) issued an international alert regarding an outbreak of Lymphogranuloma venereum (LGV) in Rotterdam in a sexual network of men who have sex with men (MSM). Further to this alert, a retrospective survey was set up by the Institut de Veille Sanitaire and the reference laboratories for N.gonorrhoeae and Chlamydia in France. Our STI clinic in Paris carried out a clinico-biological retrospective study involving 154 MSM screened for anorectal sexually transmitted infections (STIs) between January 2002 and May 2004 and a prospective study between May 2004 and August 2004. Out of 216 swabs of rectal discharge from homosexual or bisexual males, a total of 32 were positive for C. trachomatis (14.8%) (3 patients in 2002, 11 in 2003 and 18 in 2004). C. trachomatis-positive rectal strains were genotyped to detect the specific C. trachomatis serovars and revealed serovars L(2) for 22 patients (respectively 1 in 2002, 9 in 2003 and 12 in 2004). Serum antibody titers for Chlamydia trachomatis were determined among 14 subjects and revealed strongly positive in 13 cases (1/512 to 1/16384) titers of IgG. These 22 patients with clinico-biologically confirmed anorectal lymphogranuloma venereum (ARLGV) were all homosexual men. They ranged from 28 to 52 years (mean age 39.2 years). 12 of 21 (57.1%) subjects with an ARLGV diagnosis were seropositive for human immunodeficiency virus (HIV) (one not done). Although rare, anorectal lymphogranuloma venereum (ARLGV) still exists in France and should not be forgotten in the differential diagnosis of rectal problems in male homosexuals.