895    

Background:  Lymphogranuloma venereum (LGV), a sexually transmitted infection (STI) caused by C. trachomatis serovars L1, L2, or L3, is prevalent in tropical areas but occurs sporadically in the western world where most cases are imported. In 2004 an outbreak of 15 rectal LGV cases was reported in Rotterdam, the Netherlands, among men having sex with men (MSM); 13 were HIV-infected and all reported unprotected sex in neighboring countries, including Belgium, France, and the United Kingdom. Concomitantly, a rise in C. trachomatis proctitis was observed in France.

Methods:  Retrospectively, all stored rectal specimens found positive for C. trachomatis since January 2002 for by polymerase chain reaction (PCR) in 3 Paris laboratories or in the C. trachomatis national reference center were genotyped. From April 2004 onward, all the PCR rectal-positive samples isolated in men in 5 STI clinics in Paris were genotyped.

Results:  From July 2002 to August 2004, 104 cases of rectal LGV were diagnosed. Two cases were observed in 2002, 17 in 2003 (13 in the last quarter), and 85 cases in the first 8 months of 2004. Epidemiological information was obtained from the first 14 patients with rectal LGV. All were MSM reporting unprotected anal sex with anonymous male sex partners in France; none reported a stay in an endemic LGV area. The mean age of the subjects was 40 years (range: 31 to 50); 8 were HIV-infected, and 9 had another, concomitant STI. The mean duration of symptoms before LGV diagnosis was 50 days (range: 11 to 120). All 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 tumor-like stricture was observed. Following an information campaign targeting clinicians, especially proctologists, in France, the mean duration of symptoms before diagnosis was reduced by 12 days. This suggests that clinicians had been made aware of this emergence.

Conclusions:  The emergence of rectal LGV in France, but also in the Netherlands and in Belgium, characterized by deep mucosal ulcerations, frequently occurring in HIV-infected MSM, is a serious concern for the expansion of HIV in the gay community in Europe.

Keywords: rectal lymphogranoloma venereum; MSM; Europe