Ginecol Obstet Mex. 2012 Mar;80(3):208-17.

[New genovariantes of Chlamydia trachomatis serovar L2 proctitis

causing].
[Article in Spanish]
Guerra-Infante FM, Lpez-Hurtado M, Villagrana-Zesati R.

Source
Departamento de Inmunologa e Infectologa Perinatal, Instituto Nacional de Perinatologa Isidro Espinoza de los Reyes,
Mxico, DF. fguerra_96@yahoo.com

Abstract
Lymphogranuloma venereum (LGV) is a chronic disease of the lymphatic system that is transmitted sexually and whose
etiologic agents are L1, L2 and L3 serotypes of Chlamydia trachomatis. Since 2003 in Europe, USA, Canada and
Australia have had outbreaks of L2 serotype infection that develops proctitis in place of LGV in men who have sex with
men. It appears that these strains are a new genovariant of L2 serotype (L2b) that is developing a different pathology
to LGV. However, the analysis of L2b genome not differs significantly to L2 genome (L2/434 UB) for which L2b is
considered as a classic L2 strain. Despite this, new genovariantes of L2 and L2b are appearing, which develop or
not LGV or proctitis so we need to do an analysis of its genome to identify genetic changes that these strains shown.
2012 Mar; 80 (3) :208-17.

[ genovariantes L2
].
[ ]
- FM

, - M , Villagrana Zesati-R .

Departamento Inmunologa Infectologa , Perinatologa

---, Mxico, DF. fguerra_96@yahoo.com

( LGV )
,
L1, L2 L3 . 2003 ,
, L2,
LGV , . , genovariant
L2 (L2b), LGV . ,
L2b L2 (L2/434 UB), L2b
L2. , genovariantes L2 L2b ,
LGV ,
, .

Dis 2010 , 37 (12) :789-95.

1

 IgA -
.
HJ , V , S Ouburg , Pleijster J , Geskus , Speksnijder AG , Fennema JS , Morre SA .

STI , ,
(Amsterdam GGD), , .hjdevries@amc.nl

:
( LGV ) , Chlamydia L
(Ct + / LGV +), , ().
LGV Ct (Ct + / LGV -) 1 ,
Ct + / LGV + 3- . Ct + /LGV + Ct
+ / LGV - , (Naat)
, .
.
:
Ct + / LGV + Ct + / LGV -
Naat L- Naat.
- - (MOMP) antilipopolysaccharide
IgA IgG . : (1)
(2) (, <10
). 100 Ct + / LGV + 100 +
Ct / LGV - , .
:
-IgA MOMP Ct + / LGV + (n = 42) Ct + / LGV (n = 19) 85,7% (95% [] 72.2-93.3) 84,2 %
(95% CI, 62.4-94.5), . , 98 Ct + / LGV + 105 +
Ct / LGV - , -IgA MOMP ,
2,0 75,5% (95% CI, 65.8-83.6) 74,3% (95% CI, 64.8-82.3) .
:
IgA -MOMP () LGV
. , L- Naat -
.
2010 Dec;37(12):789-95.
Anal lymphogranuloma venereum infection screening with IgA anti-Chlamydia trachomatis-specific major
outer membrane protein serology.
de Vries HJ, Smelov V, Ouburg S, Pleijster J, Geskus RB, Speksnijder AG, Fennema JS, Morr SA.
Source
STI outpatient clinic, Cluster Infectious Diseases, Public Health Service of Amsterdam (GGD Amsterdam),
Amsterdam, The Netherlands. h.j.devries@amc.nl
Abstract
BACKGROUND:
2

Anal lymphogranuloma venereum (LGV) infections, caused by Chlamydia trachomatis biovar L (Ct+/LGV+), are
endemic among men who have sex with men (MSM). Anal non-LGV biovar Ct infections (Ct+/LGV-) can be
eradicated with 1 week doxycycline, whereas Ct+/LGV+ infections require 3-week doxycycline. To differentiate
Ct+/LGV+ from Ct+/LGV- infections, biovar-specific Nucleic Acid Amplification Test (NAAT) are standard, but
also expensive and laborious. A chlamydia-specific serological assay could serve as an alternative test.
METHODS:
MSM were screened for anal Ct+/LGV+ and Ct+/LGV- infections with a commercial nonspecific NAAT and an in
house biovar L-specific NAAT. Serum samples were evaluated with chlamydia-specific anti-Major Outer
Membrane Protein (MOMP) and antilipopolysaccharide assays of IgA and IgG classes. Asymptomatic patients
were identified as: (1) no anal complaints or (2) no microscopic inflammation (i.e., <10 leucocytes per high power
field in anal smears). The best differentiating assay was subsequently evaluated in 100 Ct+/LGV+ and 100
Ct+/LGV- MSM using different cut-off points.
RESULTS:
The anti-MOMP IgA assay was the most accurate to differentiate Ct+/LGV+ (n = 42) from Ct+/LGV- (n = 19)
with 85.7% sensitivity (95% confidence interval [CI], 72.2-93.3) and 84.2% specificity (95% CI, 62.4-94.5), even
among asymptomatic patients. In a population comprising 98 Ct+/LGV+ and 105 Ct+/LGV- patients, the antiMOMP IgA assay scored most accurate when the cut-off point was set to 2.0 with 75.5% (95% CI, 65.8-83.6)
sensitivity and 74.3% (95% CI, 64.8-82.3) specificity.
CONCLUSIONS:
The IgA anti-MOMP assay can identify a considerable proportion of the (asymptomatic) anal LGV infections
correctly. Yet, biovar L-specific NAAT are still the preferred diagnostic tests in clinical settings.
Eur J Clin Microbiol Infect Dis. 2010, 29 (8) :917-25. Epub 2010 28.
: ,
, .
Martin-Iguacel R , Llibre JM , Nielsen H , Heras E , L , R , Clotet B , G Sirera .

, Aalborg , University Hospital, Hobrovej 18, ,

. raquel@bisaurin.org

( LGV ) (),
L1-L3 Chlamydia. 2003 ,
LGV , ,
() .
, .
. , L2b,
.
LGV , ,
LGV . ,
, , .
, LGV
.
2010 Aug;29(8):917-25. Epub 2010 May 28.
Lymphogranuloma venereum proctocolitis: a silent endemic disease in men who have sex with men in
industrialised countries.
3

Martin-Iguacel R, Llibre JM, Nielsen H, Heras E, Matas L, Lugo R, Clotet B, Sirera G.

Source
Department of Infectious Diseases, Aalborg Hospital, Aarhus University Hospital, Hobrovej 18, Aalborg,
Denmark. raquel@bisaurin.org
Abstract
Lymphogranuloma venereum (LGV) is a sexually transmitted disease (STD) caused by serovars L1-L3 of
Chlamydia trachomatis. Rare in the western world prior to 2003, different outbreaks or clusters of LGV have been
reported in Europe, North America and Australia among men who have sex with men (MSM) over the past few
years. The majority were HIV infected MSM with high-risk sexual behaviour and a high rate of concomitant STD,
including hepatitis C. Most of them presented with a proctitis syndrome and only a few with the classical bubonic
form. A previously non-described serovar, L2b, has been identified as the main causative agent of the epidemic. A
delay in diagnosis has been the rule because of the misleading symptomatology of LGV proctitis, the unfamiliarity
of the disease to physicians, and the lack of a routine diagnostic test for LGV serovars. It is crucial to increase the
awareness of the disease among physicians for prompt diagnosis and treatment, to avoid complications, and to stop
ongoing transmission. It has additional public health implications since LGV may facilitate the transmission and
acquisition of HIV and other STD.
Int J STD 2010, 21 (4) :265-6.
L2b .
R , T , Vale , Nunes H , E , C , Mansinho K , Martins Pereira F .

Unidade Doenas Sexualmente Transmitidas / Higiene Medicina ,

, . ritacastro@ihmt.unl.pt

, L2, ( LGV ),
,
(), , , .
,
L2. L
() .
(> / = 10.000) L2b OMP 1
. LGV
L2b , , .
2010 Apr;21(4):265-6.
Lymphogranuloma venereum serovar L2b in Portugal.
Castro R, Baptista T, Vale A, Nunes H, Prieto E, Arajo C, Mansinho K, da Luz Martins Pereira F.
Source
Unidade de Doenas Sexualmente Transmitidas/Instituto de Higiene e Medicina Tropical, Lisboa, Portugal.
ritacastro@ihmt.unl.pt
Abstract
4

Chlamydia trachomatis, serovar L2, is the causative agent of lymphogranuloma venereum (LGV), which during
recent years has been responsible for various outbreaks reported among men who have sex with men (MSM) in
Western Europe, America, Canada and Australia. Samples from nine patients with chronic proctitis, seen at a local
hospital were sent to us for identification of C. trachomatis serovar L2. The presence of C. trachomatis serovar L
DNA was identified by realtime polymerase chain reaction (PCR) in two patients. They both had high positive C.
trachomatis antibody titres (>/=10,000) and were found to be infected with serovar L2b by sequencing after
amplification of the omp 1 gene by a nested PCR technique. These two individuals met the diagnostic criteria
for LGV serovar L2b infection and, to our knowledge, these are the first cases described in Portugal.
. Aliment Pharmacol Ther 2010 ; 32 (1) :59-65. Epub 2010 25.
12
-.
Soni S , R Srirajaskanthan , SB , S , T Wong , JA .

, .
. suneetasoni@gmail.com <suneetasoni@gmail.com>

NHS

Foundation

Trust,

:
( LGV ) . ,
IBD LGV .
:
,
IBD, LGV ,

.
:
LGV ,
. LGV

LGV -

,
.
LGV - .
:
LGV . ,
,

. LGV -
.
:
LGV , ,
, IBD.
, LGV .
2010 Jul;32(1):59-65. Epub 2010 Mar 25.
Lymphogranuloma venereum proctitis masquerading as inflammatory bowel disease in 12 homosexual
men.
Soni S, Srirajaskanthan R, Lucas SB, Alexander S, Wong T, White JA.
5

Source
Department of Genitourinary Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
suneetasoni@gmail.com <suneetasoni@gmail.com>
Abstract
BACKGROUND:
Lymphogranuloma venereum (LGV) is a recognized cause of proctitis. Symptoms, endoscopy and histology
findings are similar in IBD and LGV proctitis.
AIMS:
To characterize the clinical, endoscopic and histological features seen in men diagnosed initially with IBD and
subsequently with LGVproctitis, and to attempt isolation of Chlamydia trachomatis DNA from the stored rectal
biopsy specimens of these patients using real-time PCR.
METHODS:
Clinical data were collated from confirmed or suspected cases of LGV proctitis where endoscopy and biopsy had
been performed as part of the investigation of clinical symptoms. LGV was confirmed by the detection of LGVspecific DNA from rectal swab specimens, with supportive evidence from Chlamydial serology. Stored
histological specimens from rectal biopsies were analysed retrospectively for LGV-specific DNA with molecular
techniques.
RESULTS:
Rectal biopsies had been obtained from twelve cases of LGV proctitis. Mucosal ulcers, cryptitis, crypt abscesses
and granulomas were common histological findings. Extraction of LGV-specific DNA from rectal biopsy
specimens enabled confirmation of three suspected cases.
CONCLUSIONS:
During the recent LGV proctitis epidemic among UK men who have sex with men, it has become apparent that
this infection may closely resemble IBD. Gastroenterologists should remain alert to LGV as a cause of proctitis in
this group.
Ann Dermatol Venereol 2010 Feb; 137 (2) :117-20. Epub 2009 30.
[ -1- ].
[ ]
Flexor G , Clarissou J , M Gaillet , Barbeyrac B , C Perronne , Truchis P .

Dpartement mdecine Aigue, - infectieuses . Tropicales, hpital Raymond-,

AP-HP, --, 104, .-, 92380 Garches, .

:
( LGV ) ,
L . 2003-2004 , LGV
( L2b), , ,
, -.
:
41- ,
, .
- 200 .
LGV , ( L2)
.
:
6

 LGV , LGV
. LGV
, , - .
2010 Feb;137(2):117-20. Epub 2009 Dec 30.
[Genital lymphogranuloma venereum in an HIV-1 infected patient].
[Article in French]
Flexor G, Clarissou J, Gaillet M, de Barbeyrac B, Perronne C, de Truchis P.
Source
Dpartement de mdecine aigu, service des maladies infectieuses et tropicales, hpital Raymond-Poincar, APHP, universit Versailles-Saint-Quentin, 104, boulevard R.-Poincar, 92380 Garches, France.
Abstract
BACKGROUND:
Lymphogranuloma venereum (LGV) is an uncommon sexually transmitted disease caused by the L serovars of
Chlamydiae trachomatis. Since 2003-2004, a continued outbreak of LGV proctitis (C. trachomatis serovar L2b)
has been reported in North America and Europe, including France, among homosexual males, especially with HIV
co-infection.
CASE REPORT:
A 41-year-old man presented penile ulceration of three weeks' standing, associated with a large swollen
granulomatous lesion and an inguinal lymph node but without proctitis. All lesions resolved after a three-week
course of doxycycline 200mg daily. These lesions were related to a genital bubo due to LGV as confirmed by
positive specific PCR for C. trachomatis (serovar L2) performed on the genital ulceration.
DISCUSSION:
Clinical descriptions of male genital LGV are infrequent, even during the LGV proctitis epidemic seen in Western
countries in recent years. A diagnosis of LGV must be considered in the presence of sexually transmitted genital
lesions, even atypical, especially among HIV-infected patients.
Med Wkly. 2010 3, 140 (13-14) :209-12.
, : L2
, .
Kamarashev J , CE , Mosimann J , S Luchli .

, . Jivko.kamarachev @ usz.ch

:
2003 , ( LGV )
, LGV , ()
, .
:
2003 ,
LGV
. -
.
.
7

:
2003 , , LGV L2 C.
. 11 -, 2
-.
() .
, , .
1 . 2 100
10-20
, .
:
LGV . LGV
, , ,
.
.
2010 Apr 3;140(13-14):209-12.
Lymphogranuloma venereum in Zurich, Switzerland: Chlamydia trachomatis serovar L2 proctitis among
men who have sex with men.
Kamarashev J, Riess CE, Mosimann J, Luchli S.
Source
Department of Dermatology, University Hospital, Zurich, Switzerland. Jivko.kamarachev@usz.ch
Abstract
BACKGROUND:
Whereas until 2003 Lymphogranuloma venereum (LGV) was rare in industrialised countries, there have been
increasing reports of cases of LGV proctitis in men having sex with men (MSM) over the last six years in Europe,
America and Australia.
PATIENTS AND METHODS:
After the alarming message from the Netherlands in 2003, physicians in a dermatological and STI private clinic in
Zurich started examining rectal swabs from patients with proctitis for LGV serovars of C. trachomatis on a regular
basis. A test system based on PCR with sequencing and databank comparison was used. Clinical files of all
patients with proctitis observed in this time period were examined.
RESULTS:
Since 2003 twelve cases of proctitis, all in MSM, caused by the LGV serovar L2 C. trachomatis were observed. Of
the overall 11 patients the majority were HIV positive and only 2 were HIV negative. Only one patient reported
previous sexual contacts outside Europe (Thailand) as the likely place of infection. The clinical presentation was
characterised by anorectal pain, discharge, tenesmus and change in stool frequency. Four patients were
successfully treated with a single dose of 1 g azithromycin. In all seven cases treated with doxycycline 2 x 100 mg
for 10-20 days clinical cure and a negative PCR result after treatment were observed, except for one patient lost to
follow-up.
CONCLUSIONS:
Zurich has not been spared by the recent outbreaks of LGV proctitis in MSM. Anorectal LGV infections may
progress to severe destructive changes, with formation of granulomas, strictures, and perirectal abscesses.
Increased awareness of this problem and establishment of reliable diagnostic tools are required.
Rev Clin Esp 2009, 209 (2) :78-81.
[ : - ].
8

[ ]
Vall- M , E .

- Infecciones , Atencin Primaria Drassanes, Barcelona,

Espaa. mvall.bcn.ics @ gencat.cat

Rev Clin Esp. 2009 -, 209 (7): 346.

:
( LGV ) ,
(), L. 2003 LGV
.
LGV 2007 .
:
LGV STI
2007 2008 .
:
31 2008 . ,
36 , .
28 . ()
5 .
:
LGV , . LGV
- 100
doxycycline/12 . .
, 2009 Feb;209(2):78-81.
[Lymphogranuloma venereum: an emerging cause of proctitis in homosexual men in Barcelona].
[Article in Spanish]
Vall-Mayans M, Caballero E.
Source
Unidad de Infecciones de Transmisin Sexual, Centro de Atencin Primaria Drassanes, Barcelona, Espaa.
mvall.bcn.ics@gencat.cat
Erratum in

Rev Clin Esp. 2009 Jul-Aug;209(7):346.

Abstract
BACKGROUND AND OBJECTIVE:
9

Lymphogranuloma venereum (LGV) is a systemic sexually transmitted infection (STI) caused by Chlamydia
trachomatis serovar L. Since 2003, outbreaks of LGV have been reported in homosexual men in Europe. The
objective of this study is to describe an outbreak of LGV in Barcelona in 2007.
PATIENTS AND METHODS:
Description of a clinical case series of confirmed LGV diagnosed in the STI clinic of Barcelona between
September 2007 and January 2008.
RESULTS:
Seven cases have been confirmed up to January 31, 2008. All were homosexual men, with a mean age of 36, who
were sexually promiscuous. Mean time of symptoms of proctitis was 28 days. All the patients were coinfected
with human immunodeficiency virus (HIV) for an average period of 5 years.
DISCUSSION:
This outbreak is similar to other LGV outbreaks that are occurring in Europe. LGV should be considered in the
differential diagnosis of proctitis in homosexual men and be treated with 100 mg of doxycycline/12 hours for three
weeks. Preventive interventions directed at HIV infected persons are important.
Infect. 2009, 85 (3) :180-1.
, L2b .
K , F , Ribadeau -F , Viard JP , Lecuit M , B--Barbeyrac , Lortholary O .

Centre d'Infectiologie Necker , , .

( LGV ) L2b , , (),

. L2b .
, LGV L2b. ,
-
.
2009 Jun;85(3):180-1.
Reactive arthritis associated with L2b lymphogranuloma venereum proctitis.
El Karoui K, Mcha F, Ribadeau-Dumas F, Viard JP, Lecuit M, de Barbeyrac B, Lortholary O.
Source
Centre d'Infectiologie Necker Pasteur, Paris, France.
Abstract
An ongoing outbreak of lymphogranuloma venereum (LGV) L2b proctitis, predominantly in HIV-positive men
who have sex with men (MSM), has been reported in industrialised countries. A case of reactive arthritis after L2b
proctitis is described. This case expands the spectrum of severe complications related to LGV L2b proctitis. Since
this infection may be asymptomatic, this organism should be screened for in HIV-positive MSM with symptoms
consistent with reactive arthritis.

Enferm Infecc Microbiol Clin 2009 Oct; 27 (8) :462-4. Epub 2009 1.
10

[ Chlamydia ].
[ ]
L , M , -Setas , Camino X , MJ , G .

Servicio

Microbiologa,

. luisdario.pineirovazquez @ osakidetza.net

-,

-,

:
,
.
:
177 , 2006 2008
, OmpA, .
:
: E (45,3%), D (15,3%), G (10,2%) F (9,6%).
: B, H, I, J, K LGV II.
:
(89%).
2009 Oct;27(8):462-4. Epub 2009 May 1.
[Genotyping of Chlamydia trachomatis in an area of northern Spain].
[Article in Spanish]
Pieiro L, Montes M, Gil-Setas A, Camino X, Echeverria MJ, Cilla G.
Source
Servicio
de
Microbiologa,
Hospital
luisdario.pineirovazquez@osakidetza.net

Donostia,

San

Sebastin,

Gipuzkoa,

Espaa.

Abstract
INTRODUCTION:
Circulating Chlamydia trachomatis genotypes that cause infection in our geographic area were studied with the
aim of detecting possible epidemiological peculiarities.
METHODS:
A total of 177 strains obtained between 2006 and 2008 were genotyped using a PCR with primers targeting the
ompA gene, and later sequenced.
RESULTS:
The most frequent genotypes were: E (45.3%), D (15.3%), G (10.2%) and F (9.6%). Other genotypes found were:
B, H, I, J, K and LGV II.
CONCLUSION:
The molecular assay used had a high yield (89%).
Infect. 2009, 85 (3) :173-5. Epub 2009 15.
,
: .
11

 H , S , C , G , P , D , Ling C , Paul J , Tong W , J

, Ison CA .

Imperial College London, , . h.ward @ imperial.ac.uk

:
( LGV ) LGV
() ,
().
:
- .
:
2006-7.
:
4825 6778
.
:

. Chlamydia-
- .
:
LGV LGV ; ,
.
:
( 95% ) 6,06% (5,51%
6,66%) - LGV 0,90% (0,69% 1,16%) LGV ; 3,21% (2,74%
3,76 %) - LGV 0,04% (0,01% 0,16%), LGV . LGV
(95% , ); LGV
(68%), (16%).
:
,
LGV .
LGV .
,
- .
LGV .
2009 Jun;85(3):173-5. Epub 2009 Feb 15.
The prevalence of lymphogranuloma venereum infection in men who have sex with men: results of a
multicentre case finding study.
Ward H, Alexander S, Carder C, Dean G, French P, Ivens D, Ling C, Paul J, Tong W, White J, Ison CA.
Source
Imperial College London, London, UK. h.ward@imperial.ac.uk
12

Abstract
OBJECTIVE:
To determine the prevalence of lymphogranuloma venereum (LGV) and non-LGV associated serovars of urethral
and rectal Chlamydia trachomatis (CT) infection in men who have sex with men (MSM).
DESIGN:
Multicentre cross-sectional survey.
SETTING:
Four genitourinary medicine clinics in the United Kingdom from 2006-7.
SUBJECTS:
4825 urethral and 6778 rectal samples from consecutive MSM attending for sexual health screening.
METHODS:
Urethral swabs or urine and rectal swabs were tested for CT using standard nucleic acid amplification tests.
Chlamydia-positive specimens were sent to the reference laboratory for serovar determination.
MAIN OUTCOME:
Positivity for both LGV and non-LGV associated CT serovars; proportion of cases that were symptomatic.
RESULTS:
The positivity (with 95% confidence intervals) in rectal samples was 6.06% (5.51% to 6.66%) for non-LGV CT
and 0.90% (0.69% to 1.16%) for LGV; for urethral samples 3.21% (2.74% to 3.76%) for non-LGV CT and 0.04%
(0.01% to 0.16%) for LGV. The majority of LGV was symptomatic (95% of rectal, one of two urethral cases);
non-LGV chlamydia was mostly symptomatic in the urethra (68%) but not in the rectum (16%).
CONCLUSIONS:
Chlamydial infections are common in MSM attending for sexual health screening, and the majority are nonLGV associated serovars. We did not identify a large reservoir of asymptomatic LGV in the rectum or urethra.
Testing for chlamydia from the rectum and urethra should be included for MSM requesting a sexual health screen,
but serovar-typing is not indicated in the absence of symptoms. We have yet to identify the source of most cases
of LGV in the UK.
Infect. 2009, 85 (3) :176-9. Epub 2009 Jan 28.
- ,
.
NT , . , , P , S , , Azadian B , S , M
, H , N Nwokolo .

/ , Chelsea & Westminster

. torshie.annan @ FPH-tr.nhs.uk

Hospital

NHS

Foundation

Trust,

:
, ,
(), , .
:
/ Chelsea & Westminster Hospital NHS
Foundation Trust 1 2005 29 2006
,
(). () Beckton-Dickinson -Tec Strand
. 13

 ,
( LGV )- .
:
3076 . , 8,2%
CT ( LGV LGV ) 5,4% .
- 38,1%. (69,2% (171/247))
, .
, 94,2% (227/242) 91,8% (79/86) CT
36 LGV .
:
, ,
.
, .
2009 Jun;85(3):176-9. Epub 2009 Jan 28.
Rectal chlamydia--a reservoir of undiagnosed infection in men who have sex with men.
Annan NT, Sullivan AK, Nori A, Naydenova P, Alexander S, McKenna A, Azadian B, Mandalia S, Rossi
M, Ward H, Nwokolo N.
Source
GUM/HIV Directorate, Chelsea
torshie.annan@fph-tr.nhs.uk

&

Westminster

Hospital

NHS

Foundation

Trust,

London,

UK.

Abstract
OBJECTIVE:
To determine the prevalence of rectal chlamydia infection in a cohort of men who have sex with men (MSM) and
the proportion of infection that would be missed without routine screening.
METHODS:
MSM presenting to four HIV/GUM outpatient clinics at the Chelsea & Westminster Hospital NHS Foundation
Trust between 1 November 2005 and 29 September 2006 were offered testing for rectal chlamydia infection in
addition to their routine screen for sexually transmitted infections (STIs). Chlamydia trachomatis (CT) tests were
performed using the Beckton-Dickinson Probe-Tec Strand Displacement Assay. Positive samples were re-tested at
the Sexually Transmitted Bacteria Reference Laboratory, to confirm the result and identify lymphogranuloma
venereum (LGV)-associated serovars.
RESULTS:
A total of 3076 men were screened. We found an 8.2% prevalence of infection with CT (LGV and nonLGV serovars) in the rectum and 5.4% in the urethra. The HIV and rectal chlamydia co-infection rate was 38.1%.
The majority of rectal infections (69.2%, (171/247)) were asymptomatic and would have been missed if routine
screening had not been undertaken. Of the samples re-tested, 94.2% (227/242) rectal and 91.8% (79/86) urethral
specimens were confirmed CT positive and 36 cases of LGV were identified.
CONCLUSION:
Our data show a high rate of rectal chlamydia infection, in the majority of cases it was asymptomatic. We
recommend routine screening for rectal chlamydia in men at risk, as this may represent an important reservoir for
the onward transmission of infection.
Dis 2009 Feb; 36 (2) :88-91.
: 2007
.
JP , , C , . , - , J , MJ Borrego .
14


, , .

:
LGV , ,
(). , . ,
LGV OmpA
(NIH).
:
2007 , 178 OmpA. 891bp (nt142-nt1032)
GenBank
.
:
LGV - (7 "L2" 1 E + L2
). , 4 4 .
(+) MSM LGV , ,
LGV . OmpA
L2/434 L2b/144276,
LGV .
:
7 LGV 2007
5 . LGV, , , ,
. , LGV
OmpA LGV
. LGV
.
2009 Feb;36(2):88-91.
Lymphogranuloma venereum in Portugal: unusual events and new variants during 2007.
Gomes JP, Nunes A, Florindo C, Ferreira MA, Santo I, Azevedo J, Borrego MJ.
Source
National Institute of Health, Lisbon, Portugal.
Abstract
BACKGROUND:
Several European countries identified an ongoing LGV outbreak, particularly among men who have sex with men
(MSM). In Portugal, no particular surveillance measures were launched. Nonetheless, circulating LGV strains
could eventually be detected through the routine Chlamydia trachomatis ompA genotyping procedure held in the
Portuguese National Institute of Health (NIH).
METHODS:
During 2007, 178 Chlamydia trachomatis specimens were genotyped through amplification and automatedsequencing of ompA. Sequences of 891bp (nt142-nt1032) were aligned with currently available chlamydial
sequences from GenBank to identify the corresponding genotype.
RESULTS:
15

Eight Chlamydia trachomatis specimens matched LGV-genotypes (7 "L2" and 1 mixed E+L2 undetermined
variant). These specimens were identified in samples collected from 4 women and 4 men. One HIV(+) MSM
presented LGV related symptoms, while the other infected persons were either asymptomatic or presented no
clear LGV symptoms. All samples revealed ompA sequences different from the L2/434 reference strain and from
the L2b/144276, which is the most frequently described genotype during the recent LGV outbreak.
CONCLUSIONS:
The detection of 7 LGV specimens during 2007 in contrast with their absence over the previous 5 years.
The LGV infected individuals do not seem to be related to any sexual networks of MSM, contrarily to those
described in other European countries. Moreover, all LisbonLGV specimens revealed unusual ompA sequences
that differentiate them from the currently reported LGV infections in Europe. The results of the current study
further justify an attentive surveillance of LGV strains infecting different populations and the study of their
relation with clinical aspects and disease patterns.
. 2008 , 5 (4) :369-70.
: .
, , S , C , S , T .

, MidCentral , 4414,
. anne.robertson @ midcentraldhb.govt.nz

( LGV ). , , , , ,
, LGV , ,
, . LGV .
2008 Dec;5(4):369-70.
Case report: lymphogranuloma venereum in New Zealand.
Robertson A, Azariah S, Bromhead C, Tabrizi S, Blackmore T.
Source
Sexual
Health
Service,
MidCentral
anne.robertson@midcentraldhb.govt.nz

Health,

Palmerston

North

4414,

New

Zealand.

Abstract
We report New Zealand's first two cases of anorectal lymphogranuloma venereum (LGV). Although infection in
these cases was probably acquired off-shore, the cases are reported to demonstrate the need to be vigilant to the
possibility of LGV when men who have sex with men present with symptoms of proctitis. Investigation and
management of LGV is discussed.
Int J STD , 2008 , 19 (12) :805-9.
LGV
, ?
Tinmouth J , , C , Kropp R , L Mitterni , Rachlis , S , , Sikri R ,
GR , Wesson T , T Wong , H .
16


Sunnybrook , , ,
, . jill.tinmouth @ sunnybrook.ca

LGV , (),
( LGV )
.
2006 . , ,
C.. 253 43
, 53% +. LGV , 20 (8%)
. (5%) - LGV C.
. anopenetrative ,
- LGV C. . Sub- , LGV C.
, LGV
. - LGV
.
2008 Dec;19(12):805-9.
Is there a reservoir of sub-clinical lymphogranuloma venereum and non-LGV Chlamydia trachomatis
infection in men who have sex with men?
Tinmouth J, Gilmour MW, Kovacs C, Kropp R, Mitterni L, Rachlis A, Richards S, Salit I, Sikri R, Valencia
GR, Wesson T, Wong T, Wood H.
Source
Department of Medicine Sunnybrook Health Sciences Centre, Division of Gastroenterology, Toronto, Ontario,
Canada. jill.tinmouth@sunnybrook.ca
Abstract
SUMMARY: The aim of this study was to determine if a reservoir of sub-clinical LGV infection exists in men
who have sex with men (MSM), as this finding might account for the recent rise in lymphogranuloma venereum
(LGV) Chlamydia trachomatis infections among MSM in Canada. MSM without proctitis were enrolled between
January and August 2006 in a cross-sectional study. Rectal, urine, serology and pharyngeal specimens were tested
for specific C. trachomatis serovars. The median age of the 253 participants was 43 years; 53% were HIV+. We
found no active cases of LGVinfection; but 20 (8%) participants had positive serology. Thirteen participants (5%)
had non-LGV C. trachomatis infections. Unprotected anopenetrative intercourse, rectal enema and drug use were
associated with non-LGV C. trachomatis infection. Sub-clinical rectal non-LGV C. trachomatis infection was
relatively common but LGV was not identified in our sample. Further studies of screening for nonLGV chlamydia infection in MSM are needed.
Infect. 2009, 85 (3) :171-2. Epub 2008 26.
: .
Cusini M , BONESCHI V , L Arancio , Ramoni S , L Venegoni , Gaiani F , HJ .

, , 9 Pace, 20122, Milano, . m.cusini @

policlinico.mi.it
17


( LGV ) ,
() , .
2006 , 2008 13 ,
. LGV
.
, ,
. LGV ,
, .
2009 Jun;85(3):171-2. Epub 2008 Nov 26.
Lymphogranuloma venereum: the Italian experience.
Cusini M, Boneschi V, Arancio L, Ramoni S, Venegoni L, Gaiani F, de Vries HJ.
Source
Institute of Dermatological
m.cusini@policlinico.mi.it

Sciences,

University

of

Milan,

Via

Pace

9,

20122,

Milano,

Italy.

Abstract
An epidemic of lymphogranuloma venereum (LGV) has been described in men who have sex with men (MSM) in
the western world, particularly in western Europe. The first Italian case was reported by the authors in 2006, and
up to March 2008 there have been 13 symptomatic cases, all in MSM. Ten cases had LGV proctitis and three cases
had inguinal adenopathy as their clinical presentation. The initial three cases reported receptive anal intercourse in
metropolitan areas of northern Europe, Turkey and eastern Europe, whereas the later cases were infections
acquired locally. Diagnosis was by LGV-specific real-time PCR in nine cases, by symptoms and PCR for
Chlamydia trachomatis in three cases, and in one case clinically and epidemiologically.
J Dtsch Dermatol Ges. 2008 , 6 (11) :935-40.
.
[ , ]
G , .

, , ,
, , . georg.stary @ meduniwien.ac.at

( LGV ) ,
L1 L3. C.
, LGV
. LGV .
2003 , LGV
. - ,
. L2b , ,
.
LGV , ,
LGV .
18

2008 Nov;6(11):935-40.
Lymphogranuloma venereum outbreak in Europe.
[Article in English, German]
Stary G, Stary A.
Source
Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University of
Vienna, Vienna, Austria. georg.stary@meduniwien.ac.at
Abstract
Lymphogranuloma venereum (LGV) is a venereal disease caused by Chlamydia trachomatis biovars L1 to L3.
Unlike other anogenital C. trachomatis infections, LGV preferably affects lymphatic tissue after invasion through
an epithelial surface. LGV has been considered an exotic tropical disease in Europe. This changed in 2003 as there
was an outbreak of LGV in Rotterdam followed by additional reports from other European countries and North
America. Most patients were HIV-positive men who presented with proctitis. Most of these patients were infected
by C. trachomatis L2b biovar, a variant that was first identified in patients from Amsterdam. This review will
address the recent developments of the LGV outbreak in Europe and discuss epidemiology, clinical
manifestations, new subtypes of LGV genotypes and appropriate diagnostic measures.
. G Ital Dermatol Venereol 2008 Feb; 143 (1) :83-5.
- : .
Cusini M , BONESCHI V , C , Girgenti V , H De Vries , Alessi E .

, Regina Elena , Via Pace 9, ,

.

( LGV ) ,
, - .
LGV - . LGV
L1, L2, L3, .
LGV , ,
, , , , ,
, . 2004 LGV-
-
, .
.
CT L2; .
2008 Feb;143(1):83-5.
Ano-rectal lymphogranuloma venereum: the first case in Italy.
Cusini M, Boneschi V, Tanzi C, Girgenti V, De Vries H, Alessi E.
Source
Institute of Dermatological Sciences, Mangiagalli Regina Elena Policlinic Foundation, Via Pace 9, Milan, Italy.
19

Abstract
Lymphogranuloma venereum (LGV) is a sexually transmitted infection endemic in Central Africa, South-East
Asia and in some countries of Central and South America. In Italy LGV has been sporadically reported in patients
coming from abroad. The etiological agent of LGV is Chlamydia trachomatis serovars L1, L2, L3, differentiating
by pathogenetic action. The clinical course of LGV can be divided into three stages with a initial small papule,
which may ulcerate, at the site of inoculation, followed by massive lymphadenopathy, which is usually unilateral,
and eventually by lymphatic obstruction, causing elephantiasis. During 2004 a LGV ano-rectal clinical variant has
been described as an erosive proctitis among homosexual HIV-positive men in some countries of Western Europe,
not coming from endemic areas. Until now this syndrome has been often explained as chronic intestinal
inflammatory disease. This report describes a case of proctitis caused by CT serovar L2; to Authors' knowledge
this is the first case reported in Italy.
J. 2008 Aug; 87 (8) :478-80.
.
Albay DT , GE .

, UCLA Medical Center, -, 91342, .

( LGV ) - L1, L2, L3 -

. : ,
. ,
, .
LGV :
/ . ,

. LGV , ,
. ,
.
LGV -
C. LGV ,
, orogenital .
2008 Aug;87(8):478-80.
Head and neck manifestations of lymphogranuloma venereum.
Albay DT, Mathisen GE.
Source
Department of Infectious Diseases, UCLA Medical Center, Los Angeles, CA 91342, USA.
Abstract
Lymphogranuloma venereum (LGV)--caused by Chlamydia trachomatis serovars L1, L2, or L3--rarely occurs in
the United States. The disease clinically manifests in three stages: primary, secondary, and tertiary. The primary
manifestation, a self-limited genital ulcer at the site of inoculation, often is absent by the time the patient seeks
medical attention. The most common clinical manifestation of LGV is evident in its secondary stage: unilateral
tender inguinal and/or femoral lymphadenopathy. However, proctocolitis or inflammatory involvement of
perirectal or perianal lymphatic tissues resulting in fistulas and strictures may also occur. The diagnosis of LGV is
20

usually made serologically and by exclusion of other causes of inguinal lymphadenopathy or genital ulcers.
Doxycycline is the preferred treatment; it cures the infection and prevents ongoing tissue damage. This case
highlights an unusual manifestation of LGV infection--cervical lymphadenopathy following suspected
oropharyngeal infection with C trachomatis. Head and neck manifestations of LGV may become an increasing
problem in the future if sexual practices such as orogenital contact become more widespread.
J Med Microbiol 2008 ; 57 (Pt 8) :962-5.
.
S , IM , Ison C .

-, ,
, 61 Colindale Ave, NW9 5HT, . sarah.alexander @ hpa.org.uk

( LGV ) ,
(),
, LGV - - LGV
. 495
- (, ): (I)
- 1,1 OMPI
(OMPI RFLP-); (II), 36 ..
H LGV (pmpH
). , ,
94,7% (390/412) . untypeable
OMPI RFLP- - 1,1 . 83 untypeable, 19
LGV pmpH .
, . PmpH
,
. , OMPI RFLP- , -
, . LGV
. LGV
(94,7%),
, , LGV.
2008 Aug;57(Pt 8):962-5.
A comparison of two methods for the diagnosis of lymphogranuloma venereum.
Alexander S, Martin IM, Ison C.
Source
Sexually Transmitted Bacteria Reference Laboratory, Health Protection Agency, Centre for Infections, 61
Colindale Ave, London NW9 5HT, UK. sarah.alexander@hpa.org.uk
Abstract
A recent outbreak of lymphogranuloma venereum (LGV) within the men who have sex with men (MSM)
community and their requirement for extended therapy has highlighted the need for laboratory tests that
differentiate LGV- from non-LGV-associated serovars of Chlamydia trachomatis. Two previously described
methods were evaluated against 495 clinical specimens referred to the Sexually Transmitted Bacteria Reference
21

Laboratory (London, UK): (i) PCR amplification of a 1.1 kb region of the ompI gene followed by restriction
enzyme digestion (ompI RFLP-PCR); and (ii) real-time PCR targeting a 36 bp deletion present within the
polymorphic membrane protein H gene of LGV-associated serovars (pmpH real-time PCR). For specimens that
could be categorized using both methods, a 94.7 % (390/412) concordance was achieved. Eighty-three specimens
were found to be untypeable by ompI RFLP-PCR due to a failure to amplify the 1.1 kb fragment. Of these 83
untypeable specimens, 19 were determined to be an LGV-associated serovar by pmpH real-time PCR. Despite the
high level of concordance, there were differences found in the technical complexity of the two methods. The
pmpH real-time PCR exhibited greater sensitivity, a more rapid turnaround time and a lower technical
requirement. Whilst the ompI RFLP-PCR was not as robust as a laboratory diagnostic method, it did enable
serovar-level identification. LGV infection remains an important threat to the health of high-risk MSM in Europe.
In conclusion, the two methods for the detection of LGV from clinical samples were found not only to have a high
concordance (94.7 %) but also to be complementary, and could be used in an integrated way to aid LGV detection.
Surveill. 3 2008, 13 (14). PII: 8087.

( LGV ) .
M , Koedijk FD , M , MJ .

Rijksinstituut Volksgezondheid (RIVM,

), Infectieziekte-bestrijding (CIB,
), Bilthoven.

2004 ( LGV ) ,
, .
LGV 2004-2005 ,
. . 12 ,
() , 2004-2005
1 = " " 5 = "
". LGV 34 (33%) 104 .
34 ,
(100%), (71%),
(44%). 4 () ,

LGV , , ,
, . LGV
. , ,
. STI
LGV , , .
, LGV
.
2008 Apr 3;13(14). pii: 8087.
Evaluation prompting transition from enhanced to routine surveillance of lymphogranuloma venereum
(LGV) in the Netherlands.
Kivi M, Koedijk FD, van der Sande M, van de Laar MJ.
Source
22

Rijksinstituut voor Volksgezondheid en Milieu (RIVM, National Institute for Public Health and Environment),
Centrum Infectieziekte-bestrijding (CIb, Centre for Infectious Diseases Control), Bilthoven.
Abstract
In 2004, a lymphogranuloma venereum (LGV) epidemic among men who have sex with men in the Netherlands
motivated the introduction of enhanced surveillance. We evaluated the acceptability of the
enhanced LGV surveillance in the Netherlands in 2004-2005 to provide recommendations for future surveillance.
Completeness of requested patient information was analysed. All 12 sexually transmitted infection (STI) health
services participating in the 2004-2005 STI surveillance completed evaluation questionnaires and rated
surveillance system features from 1="very poor" to 5="very good". Information from enhanced LGV surveillance
was available for 34 (33%) of 104 cases. For these 34 cases, median proportions of response decreased
successively for clinical information (100%), sexual anamnesis (71%) and details about the last sex partners
(44%). A median score of 4 ("good") was assigned to simplicity, required resources and surveillance information
requested and distributed. Seven respondents favoured continuation ofLGV surveillance, whereof six preferred
modifications, usually meaning less extensive surveillance. In conclusion, the enhanced LGV surveillance was
generally regarded as adequate. However, it was limited by low completeness, underlining the need to keep
requested information to a minimum. The routine STI surveillance now includes LGV diagnosis and, following
this evaluation, the additional enhanced surveillance was discontinued. However, occasional cases justify alertness
and LGV remains under routine STI surveillance in the Netherlands.
Infect. 2008 ; 84 (4) :273-6. Epub 2008 Feb 18.
quadriplex
.
CY , Chi KH , S , Ison CA , RC .

, / , ,
, , Mail Stop: G-39, 1600 Clifton Road,
Atlanta, GA 30333, USA. cyc1@cdc.gov

:
quadriplex
( LGV ) LGV
.
:
quadriplex LGV ,
LGV -, ,
. quadriplex
- LGV
.
:
(85 89 , 95,5%)
- C ( 0,93, 95% 0,86 0,99).
34 LGV , 35 - LGV C 16 . ,
- LGV ,
P quadriplex . ,
- LGV
quadriplex . , ,
23


quadriplex .
:
quadriplex - , LGV ,
LGV .
C,
.
2008 Aug;84(4):273-6. Epub 2008 Feb 18.
A real-time quadriplex PCR assay for the diagnosis of rectal lymphogranuloma venereum and nonlymphogranuloma venereum Chlamydia trachomatis infections.
Chen CY, Chi KH, Alexander S, Ison CA, Ballard RC.
Source
Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for
Disease Control and Prevention, Mail Stop: G-39, 1600 Clifton Road, Atlanta, GA 30333, USA. cyc1@cdc.gov
Abstract
OBJECTIVES:
To develop and evaluate a real-time quadriplex PCR for the diagnosis of lymphogranuloma venereum (LGV) and
non-LGV chlamydial infections using rectal swab specimens.
METHODS:
The design of the real-time quadriplex PCR assay incorporates an LGV-specific, a non-LGV-specific target
sequence, a Chlamydia trachomatis plasmid target, and the human RNase P gene as an internal control. The
performance of the quadriplex PCR was compared with a previously reported real-time duplex PCR assay on
which LGV diagnosis was based on exclusion.
RESULTS:
Very good agreement (85 of 89 specimens, 95.5%) was found between the two multiplex PCR assays for the
detection of C trachomatis DNA (kappa value 0.93, 95% CI 0.86 to 0.99). Both assays identified 34 LGV, 35 nonLGV C trachomatis and 16 negative specimens. Of two specimens that tested positive for non-LGV by the duplex
PCR, one was found to be a mixed infection and the other was positive only for plasmid and RNase P targets by
the quadriplex PCR. Two additional specimens that had equivocal results for non-LGV by the duplex PCR also
tested positive only for plasmid target and human DNA by the quadriplex PCR. In addition, six specimens that
tested negative by the duplex PCR assay were found to be invalid when using the quadriplex PCR.
CONCLUSIONS:
A real-time quadriplex PCR assay has been developed that is capable of detecting LGV, non-LGV, or mixed
infections simultaneously in rectal specimens. The assay also contains a supplemental amplification target for the
confirmation of C trachomatis infection as well as a human DNA control for monitoring sample adequacy and
PCR inhibition.
. Dis 2008 ; 35 (4) :377-82.
Chlamydia L2 ,
, .

G,T
, Bangert
C , Rieger , , Geusau .

C,N

Kohrgruber , Gmeinhart

B , Kirnbauer

R , Jantschitsch

24

 , , (DIAID),
, , . georg.stary @ meduniwien.ac.at

:
2003 ( LGV ),
L2b, , .
:

(VS) 4, VS2 VS1
(OMP) A. , -
.
:
,
. L2 15
, - (73,3%) ,
(53,4%). VS1, VS2 VS4 OmpA L2b 8 . 4
, 3 L2 VS1, VS2
VS4 , , L2c, , .
:
LGV C. L2.
OmpA L2, 1
LGV , .
2008 Apr;35(4):377-82.
New Chlamydia trachomatis L2 strains identified in a recent outbreak of lymphogranuloma venereum in
Vienna, Austria.
Stary G, Meyer T, Bangert C, Kohrgruber N, Gmeinhart B, Kirnbauer R, Jantschitsch C, Rieger A, Stary
A, Geusau A.
Source
Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases (DIAID), Medical
University of Vienna, Vienna, Austria. georg.stary@meduniwien.ac.at
Abstract
BACKGROUND:
Since 2003, an ongoing outbreak of lymphogranuloma venereum (LGV), caused by Chlamydia trachomatis biovar
L2b, has been reported among men who have sex with men.
METHODS:
Twenty-four samples positive for C. trachomatis were analyzed for specific biovars and genovariants by
genotyping of the variable segment (VS) 4, VS2 and VS1 regions of the outer membrane protein (omp) A. In
addition we assessed the patients' sociodemographic background and clinical signs and symptoms.
RESULTS:
Twenty-four men who have sex with men presented with either anorectal or inguinal symptoms and tested positive
for C. trachomatis DNA. Of these, the L2 genotype accounted for 15 patients, with a high coinfection rate with
HIV (73.3%) and other sexually transmitted infections (53.4%). Analysis of the VS1, VS2, and VS4 regions of the
ompA gene revealed the variant L2b in 8 patients. In 4 patients, 3 new L2 sequences were identified with
nucleotide changes in the VS1, VS2, and VS4 region, respectively, defining new strains designated L2c, d, e.
25

CONCLUSIONS:
This outbreak of LGV represents the further spread of C. trachomatis L2 infection. Sequence analysis of ompA
regions shows heterogeneity of L2 variants, suggesting more than 1 source of the LGV infections diagnosed in
Vienna.
. Res 2008 Jan; 18 (1) :161-71. Epub 2007 21.
: .
Thomson NR , Holden MT , C , N , Lockey SJ , Marsh P , P , ' CD , Goodhead
, Norbertzcak H , B Harris , -D , R Rance , MA , Parkhill J , RS Stephens , .

, Wellcome Trust Sanger Wellcome Trust

Campus, Hinxton, Cambridge, CB10 1SA, .nrt@sanger.ac.uk

,
, , . biovariants
: ( AC) pathovars; DK
( LGV ). , DK
, LGV ,
.
() ( D)
. , LGV ,
"" LGV .
LGV ,
,
, ,
interstrain . , ,
LGV ,
, , .
2008 Jan;18(1):161-71. Epub 2007 Nov 21.
Chlamydia trachomatis: genome sequence analysis of lymphogranuloma venereum isolates.
Thomson NR, Holden MT, Carder C, Lennard N, Lockey SJ, Marsh P, Skipp P, O'Connor CD, Goodhead
I, Norbertzcak H, Harris B, Ormond D, Rance R, Quail MA, Parkhill J, Stephens RS, Clarke IN.
Source
The Pathogen Sequencing Unit, The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton,
Cambridge, CB10 1SA, UK. nrt@sanger.ac.uk
Abstract
Chlamydia trachomatis is the most common cause of sexually transmitted infections in the UK, a statistic that is
also reflected globally. There are three biovariants of C. trachomatis: trachoma (serotypes A-C) and two sexually
transmitted pathovars; serotypes D-K and lymphogranuloma venereum (LGV). Trachoma isolates and the sexually
transmitted serotypes D-K are noninvasive, whereas the LGV strains are invasive, causing a disseminating
infection of the local draining lymph nodes. Genome sequences are available for single isolates from the trachoma
(serotype A) and sexually transmitted (serotype D) biotypes. We sequenced two isolates from the remaining
biotype, LGV, a long-term laboratory passaged strain and the recent "epidemic" LGV isolate-causing proctitis.
26

Although the genome of the LGV strain shows no additional genes that could account for the differences in
disease outcome, we found evidence of functional gene loss and identified regions of heightened sequence
variation that have previously been shown to be important sites for interstrain recombination. We have used new
sequencing technologies to show that the recent clinical LGVisolate causing proctitis is unlikely to be a newly
emerged strain but is most probably an old strain with relatively new clinical manifestations.
Infect. 2007 , 83 (4) :324-6. Epub 2007 25.
.
Jebbari H , S , H Ward , B , M Solomou , Thornton , G , J ,
P , Ison C ; LGV .

, , , . catherine.ison @ hpa.org.uk.

:
( LGV )
2007 .
:
LGV

LGV (L1-3).
.
:
2004 2007 , 492 LGV
423. 2005
32 , 2006 12
. , , -.
, 99% , 40
(91%). Co- : (74%); (14%), (5%)
, , B. ,
10 3 23% (47) 13% (15) 2005-2006 .
:
. LGV

-
.
LGV 2006 , , LGV
.
2007 Jul;83(4):324-6. Epub 2007 Jun 25.
Update on lymphogranuloma venereum in the United Kingdom.
Jebbari H, Alexander S, Ward H, Evans B, Solomou M, Thornton A, Dean G, White J, French P, Ison
C; UK LGV Incident Group.
Source
Health Protection Agency, Centre for Infections, London, UK. catherine.ison@hpa.org.uk.
Abstract
27

OBJECTIVES:
This report updates the UK epidemiology of lymphogranuloma venereum (LGV) to the end of April 2007.
METHODS:
The Health Protection Agency's Centre for Infections undertakes laboratory testing for LGV and subsequent
epidemiological investigation of cases after laboratory confirmation of the LGV serovars (L1-3). Data analysis of
enhanced surveillance and laboratory reports was undertaken.
RESULTS:
From October 2004 to end April 2007, 492 cases of LGV have been diagnosed and enhanced surveillance forms
have been returned for 423. Cases peaked in the third quarter of 2005 with an average of 32 cases per month, while
in 2006 this fell to 12 cases per month. Nationally, the outbreak is focused in London, Brighton and the North
West. All cases are in men, 99% of whom are MSM, with a median age of 40 and predominantly white ethnicity
(91%). Co-infection remains considerable: HIV (74%); hepatitis C (14%); syphilis (5%); and other STIs including
gonorrhoea, genital herpes and hepatitis B. The number of men reporting greater than 10 sexual contacts in the
previous 3 months has reduced from 23% (47) to 13% (15) from 2005-2006.
DISCUSSION:
The epidemic continues in the mostly white MSM population of the UK. The demographics of LGV remain
similar to those previously described and high levels of HIV co-infection continue. Reduced numbers of sexual
contacts might be contributing to the reduced numbers of LGVseen in 2006 but could simply mean that LGV is
moving out of the highest risk groups.

. .. (:
)

, ( , )

()

Treponema pallidum
Neisseria gonorrhoeae
Haemophilus ducreyi

( )

Chlamydia trachomatis ( -) ( L1, L2, L3)

()

Calymmatobacterium granulomatis

( )

Mycoplasma hominis, Ureaplasma urealyticum, Mycoplasma genitalium

28

Gardnerella vaginalis, Bacteroides, Prevotella, Porphyromonas,Peptostreptococcus,

Mobiluncus, Mycoplasma hominis
Shigella species

Staphilococcus aureus, Streptococcus agalactiae (. B), Streptococcus pyogenus

,
. A), E. coli, Proteus, Klebsiella, Haemophilus influensae, Peptococcus,

Peptostreptococcus

, ( , )

/
Herpes simplex virus

Cytomegalovirus hominis

Hepatitis A B virus ,
Papillomavirus hominis

Pox virus (Molluscovirus

hominis)
Retro-virus VIH 1 -
VIH 2
/

Trichomonas vaginalis

Entamoeba histolytica
Lamblia (Giardia) intestinalis
Candida

Phthirus pubis

Sarcoptes scabiei
29

- 10 ,

Treponema pallidum
Neisseria gonorrhoeae

Trichomonas vaginalis
Trichomonas vaginalis

Herpes simplex virus

Papillomavirus hominis

Chlamydia trachomatis (
()
L1, L2, L3)

Haemophilus ducreyi

( )

Calymmatobacterium granulomatis
( )

3-5 (
200% )

20-29 ,

(17,5%

)
(
, C.trachomatis, **)

- ,
hlamydia trachomatis , C.trachomatis
*
* , 2004

A56.0
A56.1
30

A56.2

A56.3

56.4

A56.8 , ,

74.9

600 000 .
15-19
(800\100 . ),
-1000\100 . C.trachomatis 12-60%
;
5-10% - ;
20-70% .
:

( )
( )
*
80% ; 30% :

31

N.gonorrhoeae(25-50%)
C.trachomatis..(25-47%)

-
Bacteroides
Peptostreptococcus
G.vaginalis, Str.spp., E.coli . (25-60%)

:
spp.,
spp.,

M.hominis?, U.urealyticum ?

()
C.trachomatis : N.gonorrhoeae, , ,
, - , Candida.

*
75% :

C.trachomatis

()
() ()

32

 ()
--
()

( )

U.urealyticum
; ; ;
;
M.genitalium
; ;
33

 , ,
, , ,
, .

U.urealyticum
- , -

M.genitalium
-

C.trachomatis

,

-

(,PCR, LCR)

Real-time PCRReal-time PCR
(IgJ, IgA,IgM)
.
, (,
, , )

, C.trachomatis

C.trachomatis
, Neiseria gonorrhoeae

C.trachomatis

: .
34

()

, , , ,

, (
)

CDC (Center for Disease Control and Prevention, )

- 100
1 ;
- 1 ,
;
2 - 7 ;
100 , 2 - 7 ;
100 , 2

;
- 1 ;
- 500
4- 7

-7;
- 500 4
500

-7;
800
3 - 7 ; 500
35

 250 , 2
- 7
4 - 7 ;
300 , 2 7
4 - 7 300 2 7 ;
400 1 - 7
150 , 2
- 7 ;

1.
o
o

2.

:
- 100 2 7
- 1,0
:

- 250 2 7

- 500 4 7

- 150 2 7

- 200 2 7

( )

36

 ( )

( - )
- in vitro, 90, /1

37

Chlamydia trachomatis
Ureaplasma urealyticum

/-

(n = 123)

4,5
500

4,5 500
2 15

2 15

C.trachomatis *

73,4

57,7

55,1

46,1
38

 -
2-4 ,
-
, ( in-vitro
24 )
:

-
-, -

4
-
, (
)

, ,

500 1 7
+
500 1 7
= 14
- - ,
2 500
-

500
39


1
Chlamydia

:
2010
:
2013
:
. Lanjouw
1
JM Ossewaarde
2,3
.
4
F.
5
:
WI Meijden
6,7
1
, Erasmus MC, ,
2
, Maasstad Ziekenhuis, ,

3
, Erasmus MC, ,

4
Venereodermatological, ,
5 Westminster Hospital Chelsea, ,
6
, Havenziekenhuis, ,
7
, Erasmus MC, ,
:
. Lanjouw MD
, Erasmus MC, ,
: +311034580 : +31107033822
: e.lanjouw @ erasmusmc.nl

1.

NAATs
C. .

()
, ,
40

 .
( )

C. .

LGV.

C. -
.
C.
, LGV , Naat
.
,
.

1 .

100
7 , 500-1000 7 ,
.
C
M. genitalium ,
500 1,
250 2-5 .
1 .
500
7 . .

C.
, , .

LGV
100 7 .

LGV ,
100 21 .
C.
, , , .

, 90
. ,
, . C. Chlamydia
Chlamydia muridarum Chlamydia .
, Chlamydophila Chlamydophila psittaci,
41

 .
1
15
C. : (
AC), ( DK), (LGV)
( L1-L3). ,

LGV . .

. , ( , ,

) , LGV.
75%.
2
,
.


90%



(PID)


3,4



-


Endocervical



50%
Non-



5,6


" "
, (" )

42


, ,
/ .
7

8-10
PID

Salpingitis


SARA ( )
10 C. PID,
. PID, Neisseria
, PID, C. ,
( III).
11

PID.
12
C.
(SARA)
(-- ), (), ,
1
Chlamydia

:
2010
:
2013
:
. Lanjouw
1
JM Ossewaarde
2,3
.
4
F.
5
:
WI Meijden
6,7
1
, Erasmus MC, ,
2
, Maasstad Ziekenhuis, ,

3
, Erasmus MC, ,

43

4
Venereodermatological, ,
5 Westminster Hospital Chelsea, ,
6
, Havenziekenhuis, ,
7
, Erasmus MC, ,
:
. Lanjouw MD
, Erasmus MC, ,
: +311034580 : +31107033822
: e.lanjouw @ erasmusmc.nl

1.

NAATs
C. .

()
, ,
.
( )

C. .

LGV.

C. -
.
C.
, LGV , Naat
.
,
.

1 .

100
7 , 500-1000 7 ,
.
C
M. genitalium ,
500 1,
250 2-5 .
44

 1 .
500
7 . .

C.
, , .

LGV
100 7 .

LGV ,
100 21 .
C.
, , , .

, 90
. ,
, . C. Chlamydia
Chlamydia muridarum Chlamydia .
, Chlamydophila Chlamydophila psittaci,
.
1
15
C. : (
AC), ( DK), (LGV)
( L1-L3). ,

LGV . .

. , ( , ,

) , LGV.
75%.
2
,
.


90%



(PID)


3,4


45


-


Endocervical



50%
Non-



5,6


" "
, (" )


, ,
/ .
7

8-10
PID

Salpingitis


SARA ( )
10 C. PID,
. PID, Neisseria
, PID, C. ,
( III).
11

PID.
12
C.
(SARA)
(-- ), (), ,
.

( III)
13-15

46

( III).
16-19

L1-L3 C.
2004
2003
, ().
20-22
: proctum
:



-


MSM . LGV
1976 .
23
LGV
, ,
.
24,25
, ,
, .
26,27


(NAATs)

()
(DFA)
NAATs ,
NAATs ( I, ).
28
NAATs
NAATs

NAATs.

.
29
,
NAATs , , ,

( I).
30
, , , C.
47

 ,
( IV).
Naat
.
, , ,
,
, ..
Naat.
31
NAATs
( II).
32

LGV
C.
LGV
LGV ,
. NAATS LGV C
1
Chlamydia

:
2010
:
2013
:
. Lanjouw
1
JM Ossewaarde
2,3
.
4
F.
5
:
WI Meijden
6,7
1
, Erasmus MC, ,
2
, Maasstad Ziekenhuis, ,

3
, Erasmus MC, ,

4
Venereodermatological, ,
5 Westminster Hospital Chelsea, ,
6
, Havenziekenhuis, ,
7
48

 , Erasmus MC, ,
:
. Lanjouw MD
, Erasmus MC, ,
: +311034580 : +31107033822
: e.lanjouw @ erasmusmc.nl

1.

NAATs
C. .

()
, ,
.
( )

C. .

LGV.

C. -
.
C.
, LGV , Naat
.
,
.

1 .

100
7 , 500-1000 7 ,
.
C
M. genitalium ,
500 1,
250 2-5 .
1 .
500
7 . .

C.
49

 , , .

LGV
100 7 .

LGV ,
100 21 .
C.
, , , .

, 90
. ,
, . C. Chlamydia
Chlamydia muridarum Chlamydia .
, Chlamydophila Chlamydophila psittaci,
.
1
15
C. : (
AC), ( DK), (LGV)
( L1-L3). ,

LGV . .

. , ( , ,

) , LGV.
75%.
2
,
.


90%



(PID)


3,4



-


Endocervical
50




50%
Non-



5,6


" "
, (" )


, ,
/ .
7

8-10
PID

Salpingitis


SARA ( )
10 C. PID,
. PID, Neisseria
, PID, C. ,
( III).
11

PID.
12
C.
(SARA)
(-- ), (), ,
.

( III)
13-15

( III).
16-19

L1-L3 C.
2004
51

 2003
, ().
20-22
: proctum
:



-


MSM . LGV
1976 .
23
LGV
, ,
.
24,25
, ,
, .
26,27


(NAATs)

()
(DFA)
NAATs ,
NAATs ( I, ).
28
NAATs
NAATs

NAATs.

.
29
,
NAATs , , ,

( I).
30
, , , C.
,
( IV).
Naat
.
52

 , , ,
,
, ..
Naat.
31
NAATs
( II).
32

LGV
C.
LGV
LGV ,
. NAATS LGV
C.
-, , LGV .
( II, ).

:


NAATs , ,
(MOMP), . , NAATs

. 4,0

33
.
34
,
NAATs. , NAATs

C. . , ,

. ,

35
,
.
36-38
Matsumoto . ,

.
39
, . 40
,
9
53

 .
40

. , .
41
,
( III).
25% C. Ripa
. C. 377
, NAATs.
42,43
, NAATs 20% 65%
. .
44


45
,
. Naat
( I, ).
,

( II,
B).

LGV
, , (ESSTI),

.
21,46
, ()
( II,
..

. , .
,
.
. Chlamydia
trachomatis .

.
Reproductive
health
and
genital
chlamydial
infection
M.A.Gomberg
Chair of dermatology and venerology of Moscow State University of Medicine and Dentistry
Summary
A review. Genital chlamydial infection is the most common sexually transmitted disease. Even subclinical low
grade infection poses threat to reproductive function of both women and men. For the prevention of untoward
reproductive outcomes it is very important to administer adequate therapy as soon as possible. State-of-the-art
clinical guidelines recommend routine screening for chlamydial infection and treatment of all cases of C.
54

trachomatis
Key
words:

genital

infection
chlamydial

infection,

during
prevention

of

pregnancy.
infertility.

- . , . . . Email:
magomberg@mail.ru
Chlamydia trachomatis , 90
,
(), [1]. ()
,
.

.
C. trachomatis genital [2, 3].
. ,
, ,
(), () () ,

.
.
, , ,
, ,
,
. 20% , 4%
, 3% , 2%
(Westrom, 1980, 1994). ,
[4].
, ,

[4]. : :
.

10% C. trachomatis .
, , Neisseria gonorrhoeae, ,
C. trachomatis, , ,

[5].
c , ,
.. [6]. Henry-Suchet
1980 . [7]. :
1)

;
2) C. trachomatis
.

, ,

[8].

, ,
1979 . [9]. [10],
,
55

 [10]. [11]
74,7% , ,
6 , ,
. 10%.

2- 20% 40% 3- [12].

, ,

.
,

.
, [4].
,

[13].
, 11%
, , [14].
,
60 [15], .
() 60 .
60,
. , 60

[16].
,
,

[6].

I
[4]. ,

[17,
18].
7 , ,
[19]. , 2

[20],

C.
trachomatis
.

[2124]. ,
,

[6].
, C. trachomatis
, , [25, 26].
C. trachomatis

[27].

C.
trachomatis

C. trachomatis

[28,
4].
C. trachomatis
56

 [29, 30].
.
.
.

,
Eckert . (2004 .),
7- ,
, [31].
[32],

.
,
.

[33].
2010 .
, C. trachomatis (
CDC, , 2006 .).

.
, ,
,

.
, CDC
1 100

7 [34]. , 7-

9798%

[35,
36].
,
, [35].

[37].
5001000
2 7 .
CDC, 7-
500 4 ,
800 4 , 300 2 , 500
1 [34]. ,

.
.
587 , ,
. , ,
, , .
[38]. ,
CDC .
(1 ).
500 4 7 ( CDC
57

 3 ). ,
[39],
. [40].
CDC,
4 7 :
500 250 14 , 800 400 14 .
, CDC,
, , .

, , , .
. trachomatis ,
( 1014 )
, .
C. trachomatis [41, 42].
.
[43].

, .
. .

C. trachomatis .
77
SURVEILLANCE REPORT Sexually transmitted infections in Europe 19902009
6.1 Key points
In 2009, 245 cases of lymphogranuloma venereum
have been reported from five EU/EEA countries.
Almost all cases were diagnosed in men who have
sex with men (98%) and the majority (75%) was coinfected
with HIV (for those with information).
Reporting is highly affected by available diagnostics,
and the true incidence of LGV is unknown.
6.2 Discussion
In 20002009, cases of lymphogranuloma venereum
(LGV) have been reported from 16 countries of which
only five reported more than zero cases (Belgium,
Denmark, Ireland, Netherlands and United Kingdom).
Additional countries have reported zero cases for LGV
(Cyprus, Czech Republic, Estonia, Finland, Hungary,
Latvia, Luxembourg, Malta, Poland, Slovenia and
Sweden). No information is available for the remaining
countries (Table 6.1).
Table K specifies the source of the data, the type of data
(aggregate and case-based), the coverage (either sentinel
or comprehensive) and period of availability for the
five countries that actually have reported LGV cases.
58

The table shows the existing heterogeneity in systems

and reporting periods. Rates per 100 000 population
were not calculated for LGV.
In 2009, 245 cases of LGV were reported from five countries
(2008: 327 cases). Between 2000 and 2009, 1 390
cases of LGV were reported from five countries: United
Kingdom (897 cases), Netherlands (413), Denmark (47),
Belgium (29) and Ireland (4) (Figure 6.1). From those with
known information on mode of transmission, 98% were
diagnosed in MSM. Information on age was available
for 1 385 cases, showing the highest proportion in the
3544 age group (Figure 6.2). In 2009, information on
HIV status was available for 103 cases (42%), indicating
that 75% were reported as HIV-positive, 17% as HIVnegative
and 8% as unknown. In the period 20042009,
information on HIV status was available for 489 cases
(35%of all cases in the period), indicating that 62% of
these 489 was reported as HIV-positive, 14% as HIVnegative
and 24% as unknown.
It must be noted that many countries do not report LGV
and that diagnosis of LGV is complicated by confirmation
through genotyping. Therefore it is very likely that
the true incidence is greatly underestimated.
The emergence of rectal LGV among MSM in western
Europe and other parts of the world was first described
in 20032. The agent, Chlamydia trachomatis serotype
L2, causes severe anorectal infections, mainly proctitis,
tenesmus, constipation and anal discharge. The majority
of LGV patients are co-infected with HIV, reported
large numbers of partners and had unprotected anal
intercourse. After the initial reports, more cases were
reported from a number of countries (Belgium, Germany,
France, Italy, Portugal, Spain, Sweden and the United
Kingdom, and also in the USA and Canada)3. Enhanced
surveillance systems and strengthened case ascertainment
have been initiated in the Netherlands, France and
the United Kingdom.
2 Nieuwenhuis RF, Ossewaarde JM, Gtz HM et al. Resurgence of
lymphogranuloma venereum in Western Europe: an outbreak of
Chlamydia trachomatis serovar L2 proctitis in the Netherlands among
men who have sex with men. Clin Infect Dis 2004;39(7):996-1003.
3 Van de Laar M. The emergence of LGV in Western Europe: what do
we know, what can we do? Euro Surveill 2006;11(9):146-8. Available
from: http://www.eurosurveillance.org/em/v11n09/1109-221.asp
6,1
2009 , 245
/ .
59

 ,
(98%) (75%)
( , ).
,
LGV .
6,2
2000-2009 ,
(LGV) 16 ,
(,
, , ).
LGV
(, , , , ,
, , , ,
).
(. 6,1).
K ,
( ), (
)
, LGV .

. 100 000
LGV.
2009 , 245 LGV
(2008 .: 327 ). 2000 2009, 1 390
LGV :
(897 ), (413), (47),
60

 (29) (4) (. 6,1). ,

, 98%
.
1 385 ,
35-44 (. 6.2). 2009
- 103 (42%),
75% -, 17% HIVnegative
8% . 2004-2009 ,
- 489
(35% ), 62%
489 -, 14% HIVnegative
24% .
, LGV
LGV
. ,
.
LGV

20032. ,
L2, , , ,
, .
LGV - ,

. ,
(, ,
, , , ,
61

, ) 3.

,
.

. , ,

11 ,

.
,
.

,
.
, .
,
, , : ;
, - ,
62

 -
.

, .

,
, .
, - :

;
;
/
.

63

 , ,
, -
.
, .


.
.

,
, .


.
, ,
.
64


, .
, :
, ,
;
, ;
- , .


;


;


,
J Eur Acad Dermatol Venereol. 2008 Apr;22(4):409-16.
65

Re-emergence of lymphogranuloma
venereum.
Kapoor S.

Source
glossomed@gmail.com

Abstract
Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by the L1,
L2 and L3 serotypes of Chlamydia trachomatis. The disease has been in the spotlight
recently because of recent outbreaks in Europe as well as the USA. A unique feature of
the recent outbreaks has been that most cases have been caused by the L2
strain. Another unique feature of these outbreaks is the fact that most cases have
occurred in men having sex with men, and most patients have presented with
proctitis. Interestingly, most recent cases have occurred in human immunodeficiency
virus-seropositive patients. Usually, the disease is divided into three phases: the primary
stage characterized by a self-healing papule, the secondary stage characterized by
proctitis or lymphadenopathy and the tertiary stage characterized by lymphedema and
anal strictures. Tests used for diagnosis include polymerase chain reactions and
compliment fixation tests. The treatment of choice is doxycycline.
( LGV ) , L1, L2 L3
. - ,
. ,
L2. ,
, ,
., . , :
,
.
. .
Sex Health. 2006 Sep;3(3):131-3.

Lymphogranuloma venereum in Australia.

Simms I, Ward H, Martin I, Alexander S, Ison C.

Abstract
Lymphogranuloma venereum (LGV), caused by C. trachomatis serovars L1, L2 and L3, is an invasive
disease capable of causing tissue destruction with many patients experiencing complex, severe
symptoms. LGV, endemic to areas of Africa, Asia, South America and the Caribbean, has emerged as a
cause of significant morbidity among men who have sex with men (MSM) in more affluent nations. The
high prevalence of HIV in LGV cases could suggest either that LGV is confined to a dense sexual

66

network, or that clinicians are selectively testing HIV-positive MSM for LGV The increase in
reported LGV cases highlights the need to improve sexual health overall among MSM; experience from
the recent syphilis outbreaks suggests that control could prove difficult.
2006 , 3 (3) :131-3.

, H , I , S , C Ison .

( LGV ), C. L1, L2 L3,

,
, , . LGV , ,
, ,
, (), .
- LGV ,
LGV , ,
- LGV LGV
;
, .
Clin Infect Dis. 2007 Jan 1;44(1):26-32. Epub 2006 Nov 27.

Lymphogranuloma venereum in the United kingdom.

Ward H, Martin I, Macdonald N, Alexander S, Simms I, Fenton K, French P, Dean G, Ison C.

Source
HIV and STI Section, Imperial College London, London, W2 1PG, United Kingdom. h.ward@imperial.ac.uk

Abstract
BACKGROUND:
Over the past 2 years, lymphogranuloma venereum (LGV), caused by L serovars of Chlamydia
trachomatis, has emerged as a significant problem among men who have sex with men (MSM). We
report on, to our knowledge, the largest case series of LGV to date, with detailed epidemiological and
clinical characteristics of the epidemic in the United Kingdom.
METHODS:
A national diagnostic service and surveillance system was established in October 2004. Cases were
confirmed by the presence of C. trachomatis and an LGV serovar (L1, L2, or L3) from genotyping. For
confirmed cases, an enhanced surveillance questionnaire was sent to the clinician.
RESULTS:
Through February 2006, a total of 327 cases of LGV were confirmed. Cases were diagnosed across the
United Kingdom, with the majority from London (71%) and Brighton (13%). Case reports were received
for 282 MSM. The majority (96%) had proctitis, many with severe local and systemic symptoms. There
was a high level of coinfection with human immunodeficiency virus (76%), hepatitis C (19%), and other
sexually transmitted infections (39%). Nine cases of human immunodeficiency virus infection were
diagnosed around the same time as LGV. Most cases were acquired within the United Kingdom, although
patients with early cases were more likely to report contacts in The Netherlands.
CONCLUSIONS:
We found a significant burden of this once-rare sexually transmitted infection among MSM in the United
Kingdom. LGV may be contributing to the epidemic of human immunodeficiency virus infection by
facilitating transmission. Further control efforts are required, including awareness campaigns, continued
detailed surveillance, and expanded chlamydiatesting among MSM.

67

Clin Infect Dis. 2007 1, 44 (1) :26-32. Epub 2006 27 .

.
H

, I , N , S , , Fenton K , P , G , C Ison .

, Imperial College London, London, W2 1PG, . h.ward @ imperial.ac.uk

:
2 , ( LGV ),
Chlamydia , , ().
, , LGV ,
.
:
2004
. C. LGV (L1, L2, L3 )
. ,
.
:
2006 , 327 LGV .
, (71%)
(13%). 282 . (96%) ,
.
(76%), (19%) ,
(39%).
, LGV .
,
.
:

. LGV
.
, - ,

68