Lymphogranuloma Venereum: An Increasingly Common Anorectal Infection Among Men Who Have Sex with Men Attending New York City STD Clinics, 2012-2015

Background:  From 2008-2011, male anorectal Chlamydia trachomatis (Ct)-positive specimens from New York City (NYC) STD clinics were routinely tested for Lymphogranuloma venereum (LGV) by polymerase chain reaction; LGV prevalence was 8.4%. When limited resources constrained clinical testing, we monitored LGV prevalence for surveillance purposes using batched random samples of archived Ct-positive specimens.  

Methods:  We tested 306 of 2,400 anorectal Ct-positive specimens collected from male STD clinic patients between 2012 and 2015 for LGV. We assessed the difference in LGV prevalence among these specimens to prevalence measured during 2008-2011, and identified predictors of anorectal LGV to guide presumptive treatment.    

Results:  Fifty-one of 306 tested specimens were LGV-positive; prevalence (16.7%; 95% C.I. 15.2-18.2%) had doubled since 2008-2011. Compared to the 255 non-LGV cases, LGV cases were significantly more likely to be non-Hispanic black (37% vs. 24%), aged >30 years (63% vs. 36%), HIV-positive (59% vs. 22%), have HIV-positive partner(s) (64% vs. 26%), have a syphilis history (cases 55% vs. 24%). Factors not associated with LGV included number of partners, condom use with receptive anal sex, concurrent rectal/urethral gonorrhea, urethral Ct. A total of 196 patients had anogenital signs/symptoms at time of anorectal specimen collection: 86.3% (44/51) of LGV cases and 59.6% (152/255) of non-LGV cases. Of all signs/symptoms referable to the anorectum, anal discharge was highly associated with LGV (OR 9.1; 95% C.I. 4.5-18.1), had highest sensitivity (59%), and reliably predicted LGV infection (positive predictive value: 67%). Absence of anal discharge by patient complaint or on exam correctly identified 91% of patients who did not have LGV.         

Conclusions:  Increasing proportions of men diagnosed with anorectal Ct infections at STD clinics have LGV. Syphilis history, HIV status, and anorectal symptoms can be used to target LGV treatment in NYC. Programs should measure anorectal LGV prevalence, and collect information on signs/symptoms of anal discharge to guide presumptive treatment.