896     A New Lymphogranuloma Venereum Strain of Chlamydia trachomatisIdentified in HIV-+ Men Having Sex in Amsterdam J Spaargaren1, Roel Coutinho*3,4, H Fennema5, S Morré6, and H de Vries2,5 1Municipal Hlth Svc, Amsterdam, The Netherlands; 2Academic Med Ctr, Univ of Amsterdam, The Netherlands; 3Academic Med Ctr, Univ of Amsterdam, The Netherlands; 4Municipal Hlth Svc, Amsterdam, The Netherlands; 5Municipal Hlth Svc, Amsterdam, The Netherlands; and 6Univ Med Ctr, Amsterdam, The Netherlands

Background:  Recently, an outbreak of lymphogranuloma venereum (LGV) was identified among men having sex (MSM) in Rotterdam. We studied whether this outbreak also occurred in Amsterdam.

Methods:  We selected MSM presenting at our sexually transmitted diseases (STD) clinic (± 20,000 new consultations/year) in 2002 and 2003 with CT proctitis based on a positive PCR test (Roche). Upon proctoscopic examination, patients were designated into 2 groups; symptomatic (n = 42) (i.e. mucopurulent anal discharge or bloody ulcerative rectal processes) or asymptomatic (n = 30) (i.e. absence of clinical inflammatory signs of the rectal mucosa). Samples were taken by proctoscopic examination. Purified CT DNA obtained from the 82 rectal PCR samples of these 72 patients were used to assess CT serovars by PCR-based RFLP analysis and sequencing of the omp-1 gene.

Results:  The samples—39 from symptomatic patients and 13 from asymptomatic patients (representing 43 patients)—were positive for LGV (genotyping and sequencing) and all contained a new variant, which we designated type L2b (GenBank AY586530). Additional data demonstrated that 31 of 37 symptomatic and 7 of 14 asymptomatic LGV patients were HIV infected. The HIV status of the other patients included in the study was unknown. The mean number of previously documented sexually transmitted infection episodes was 8.2 among the symptomatic LGV patients, almost twice the mean number of episodes among the non-LGV patients. Genital ulcers and inguinal lymphadenopathy were only detected in a few patients. All ulcers were perianal localized. The ulcers present in the 2 patients infected with a non-LGV CT strain were identified as a herpes simplex virus 2 and a Treponema pallidum-caused ulcer, respectively. In the 4 ulcers found in symptomatic patients, the L2b CT strain was detected. The age distribution was similar for the 2 groups.

Conclusions:  The outbreak of LGV among MSM in the Netherlands expands beyond the cluster reported earlier in Rotterdam and can be traced back in Amsterdam to at least January 2002. Both symptomatic and asymtomatic men are infected with LGV, most of them HIV⁺. The outbreak in Amsterdam is caused by a newly identified L2b variant.

Keywords: Lymphogranuloma venereum; HIV; L2b