Outbreaks of Lymphogranuloma Venereum (LGV) have been reported among gay, bisexual and men who have sex with other men (gbMSM) in Europe and North America. In Alberta, Canada, a universal surveillance program was initiated to assess LGV rates among gbMSM seen at provincial STI clinics. Our study examines the epidemiological characteristics and treatment of cases. We describe a prospective, multi-centre LGV surveillance program utilizing Chlamydia (CT)-positive Nucleic Acid amplification test (NAAT) specimens from gbMSM collected at three STI clinics between April 2018 and July 2022. CT-positive specimens from rectal, pharyngeal and urine specimens were sent for LGV typing. Treatment and test of cure (TOC) for LGV confirmed cases were followed. Demographic variables were compared between LGV positive and negative specimens using Chi-square tests for categorical variables and Mann-Whitney U tests for continuous variables. Eighty-five per cent (n = 2,333) of all CT positive specimens were tested for LGV and 45 (1.9%; 95% CI: 1.4%-2.5%) specimens were confirmed to be LGV. The majority (n = 1374) of specimens submitted for LGV testing were rectal swabs of which 37 (2.7%) were positive. One-half (51.2%; 22/43) of cases were asymptomatic. Of the 22 cases with a negative TOC, 9 (40.9%) patients received doxycycline 100 mg bid for 21 days, 7 (31.8%) patients received azithromycin 1 gram as a single dose, 5 (22.7%) patients received doxycycline 100 mg bid for 7 days, and 1 patient (4.6%) was treated with doxycycline 100 mg bid for 14 days. Universal testing increased detection of LGV among asymptomatic patients. Future research should consider the impact of asymptomatic LGV in transmission networks and the role of alternate, shorter treatment regimens than the recommended 21 days of doxycycline.
Gratrix et al. (Fri,) studied this question.