O12 LGV testing: are we identifying all cases in a timely manner?

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IntroductionBASHH recommends Lymphogranuloma venereum (LGV) testing of Chlamydia trachomatis (CT)-positive specimens from men who have sex with men (MSM) presenting with proctitis, and all rectal CT from HIV-positive MSM. Until recently in England, LGV testing was only available as a referred test at the Sexually Transmitted Bacteria Reference Unit (STBRU). In July 2016 we implemented a validated in-house version of the STBRU LGV PCR on all CT-positive specimens from MSM, regardless of symptoms or HIV status. We assessed the time from specimen collection to result (turnaround time, TRT) and defined clinical features of LGV cases.MethodsFrom July 2016 to March 2017 we reviewed all positive LGV tests, recording patients’ demographics, HIV status, chemsex behaviour, presence of symptoms and LGV result TRT.ResultsWe conducted 587 LGV tests on CT-positive specimens from MSM, of which 50 (8.5%) were positive. Median age of LGV cases was 38 (range 23 to 65), 28 (56%) were Caucasian, 38 (76%) were HIV positive and chemsex behaviour was reported by 20 (40%); 12 patients (24%) had a past history of LGV. Nine (18%) cases were asymptomatic and three of these were HIV-negative MSM. The mean TRT was 12 days (range 8 to 20); compared with 35 days (range 15 to 118) in the six months prior to in-house testing.DiscussionLGV continues to occur mainly in HIV-positive MSM as symptomatic proctitis. Testing all CT-positive MSM increased detection of LGV compared with following BASHH guidelines, and in-house testing reduced TRT significantly.

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