Systematic review reveals distinct coinfections, behavioral risk factors, and frequent misdiagnoses in men who have sex with men, highlighting the need for comprehensive screening.
Objective The aim of this systematic review was to explore the characteristics of men who have sex with men (MSM) diagnosed with anorectal lymphogranuloma venereum (LGV) Method Four bibliographical databases (Medline, Embase, CINAHL, Web of Science) were searched in September 2025 for publications written in English, exploring at least one characteristic in MSM with anorectal LGV. Two authors independently reviewed full-text publications, assessed the risk of bias (Joanna Briggs Institute toolkit) and performed a narrative synthesis to generate thematic data. Results 64 manuscripts published between 2004 and 2025, which included 9417 MSM with anorectal LGV. The manuscripts were case series (n=39), cross-sectional studies (n=20), case-control studies (n=4) and one cohort study. This review highlighted demographic (living with HIV, age >30 years, HIV-negative MSM using HIV pre-exposure prophylaxis (HIV-PrEP), ethnicity), co-infection (concurrent/previous non-LGV Chlamydia trachomatis , Neisseria gonorrhoeae , Treponema pallidum , anogenital herpes simplex virus, anogenital human papillomavirus, hepatitis B, hepatitis C, acute/new HIV, antimicrobial-resistant shigellosis, Giardia duodenalis , cytomegalovirus colitis), behavioural (multiple sexual partners, group sex, attending sex-on-premises venues and sex parties, oral sex, condomless anal sex, other anal sexual behaviours (penile-anal sex, oro-anal sex (rimming), sex toys, fisting, enemas/douching), recreational drug use, chemsex, injecting drug use, travel and sex) and other (diagnosed / treated erroneously for inflammatory bowel disease / lymphoma / squamous cell carcinoma, unnecessary interventions, delayed treatment) characteristics described in MSM with anorectal LGV. Conclusion Clinical guidelines should recommend that MSM with anorectal LGV require comprehensive sexually transmitted infection / HIV testing, sexual health interventions (eg, HIV-PrEP) and robust multidisciplinary clinical pathways to reduce misdiagnosis, unnecessary interventions and diagnostic delays. PROSPERO registration number CRD420251125095.
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Middleton et al. (2026) studied this question.
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