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Letter
Rectal Lymphogranuloma Venereum,
France
Magid Herida,*
Patrice Sednaoui,† Elisabeth Couturier,* Didier Neau,‡ Maïthe Clerc,§
Catherine Scieux,¶ Gerard Kreplak,# Véronique Goulet,* Françoise F Hamers,*
and Bertille de Barbeyrac§
**Institut de Veille Sanitaire, Saint-Maurice, France; †Institut Alfred
Fournier, Paris, France; ‡Hospital Pellegrin, Bordeaux, France; §Université
Bordeaux 2, Bordeaux, France; ¶Hospital Saint-Louis, Paris, France; and
#Laboratoire du Chemin Vert, Paris, France
Suggested
citation for this article
To the Editor: Lymphogranuloma venereum (LGV), a sexually transmitted
disease (STD) caused by Chlamydia trachomatis serovars L1, L2,
or L3, is prevalent in tropical areas but occurs sporadically in the western
world, where most cases are imported (1). LVG commonly
causes inflammation and swelling of the inguinal lymph nodes, but it can
also involve the rectum and cause acute proctitis, particularly among
men who have sex with men. However, LGV serovars of C. trachomatis
remain a rare cause of acute proctitis, which is most frequently caused
by Neisseria gonorrhoeae or by non-LGV C. trachomatis (2).
In 1981, in a group of 96 men who have sex with men with symptoms suggestive
of proctitis in the United States, Quinn et al. found that 3 of 14 C.
trachomatis infections were caused by LGV serovar L2 (3).
In France, 2 cases of rectal LGV were reported in an STD clinic in Paris
from 1981 to 1986 (4). In 2003, an outbreak of 15 rectal
LGV cases was reported among men who have sex with men in Rotterdam; 13
were HIV-infected, and all reported unprotected sex in neighboring countries,
including Belgium, France, and the United Kingdom (5).
At the same time, a rise in C. trachomatis proctitis (diagnosed
by using polymerase chain reaction [PCR]; [Cobas Amplicor Roche Diagnostic
System, Meylan, France]) was detected in 3 laboratories in Paris and in
the C. trachomatis national reference center located in Bordeaux.
To identify the serovars of these C. trachomatis spp., all stored
rectal specimens were analyzed by using a nested omp1 PCR-restriction
fragment length polymorphism assay. The amplified DNA product was digested
by restriction enzymes. Analysis of digested DNA was performed by electrophoresis.
Patterns were compared visually with reference patterns (6).
From January 1, 2003, to March 31, 2004, a total of 44 of 124 male rectal
swabs were positive for C. trachomatis. Of those, 38 were identified
as belonging to the L2 serotype, which confirms the diagnosis of rectal
LGV. Epidemiologic information was retrospectively obtained by clinicians
through review of medical records, telephone interview, or both. A complete
history was available for 14 of the 38 cases. All 14 men reported unprotected
anal sex with anonymous male sex partners in France, and none reported
a stay in an LGV-endemic area. Their mean age was 40 years (31–50); 8
were HIV-infected, and 9 had another concomitant STD. The mean duration
of symptoms before LGV diagnosis was 50 days (range 11–120 days). All
14 patients had symptoms of acute proctitis, including rectal pain, discharge,
and tenesmus, and 3 (all HIV-infected) had fever. Deep, extended rectal
ulcerations were reported in 8 patients, 3 of whom were HIV-infected and
had lesions suggestive of rectal carcinoma. In 1 patient in whom a late
diagnosis was made 4 months after the onset of symptoms, a rectal tumorlike
stricture was observed. All 14 patients were treated with tetracycline
for a mean duration of 16 days (range 10–60 days).
An information campaign among microbiologists and clinicians and a sentinel
LGV surveillance system were launched in April 2004. Subsequently, LGV
was diagnosed in 65 additional male patients, some retrospectively. In
total, rectal LGV was diagnosed in 103 patients from July 2002 to August
2004 (Figure).
Prompt diagnosis and treatment is indeed paramount to prevention and
control. Diagnosis may be further hampered because rectal LGV may mimic
other conditions such as rectal carcinoma or Crohn disease. Treatment
duration should be no shorter than 21 days, and follow-up examinations
should be conducted until all signs and symptoms have resolved (7,8).
If left untreated, rectal LGV could lead to serious complications such
as rectal stricture (1). If recently exposed to infection,
sexual contacts should receive prophylactic treatment to prevent reinfection
and to eliminate a potential reservoir. The emergence of rectal LGV, characterized
by deep mucosal ulcerations and frequently occurring in HIV-infected men
who have sex with men, is a serious concern for the gay community in Europe.
References
- Perrine PL, Stamm WE. Lymphogranuloma venereum. In:
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Dis. 2004;38:300–2.
- Quinn TC, Goodell SE, Mkrtichian E, Schuffler MD, Wang SP, Stamm WE,
et al. Chlamydia
trachomatis proctitis. N Engl J Med. 1981;305:195–200.
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- Clinic Effectiveness Group. National guidelines for the management
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Suggested citation
for this article:
Herida M, Sednaoui
P, Couturier E, Neau D, Clerc M, Scieux C, et al. Rectal lymphogranuloma
venereum, France [letter]. Emerg Infect Dis [serial on the Internet].
2005 Mar [date cited]. Available from http://www.cdc.gov/ncidod/EID/vol11no03/04-0621.htm
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