Lymphogranuloma venereum in Portugal: unusual events and new variants during 2007.

BACKGROUND: Several European countries identified an ongoing LGV outbreak, particularly among men who have sex with men (MSM). In Portugal, no particular surveillance measures were launched. Nonetheless, circulating LGV strains could eventually be detected through the routine Chlamydia trachomatis ompA genotyping procedure held in the Portuguese National Institute of Health (NIH). METHODS: During 2007, 178 Chlamydia trachomatis specimens were genotyped through amplification and automated-sequencing of ompA. Sequences of 891bp (nt142-nt1032) were aligned with currently available chlamydial sequences from GenBank to identify the corresponding genotype. RESULTS: Eight Chlamydia trachomatis specimens matched LGV-genotypes (7 "L2" and 1 mixed E+L2 undetermined variant). These specimens were identified in samples collected from 4 women and 4 men. One HIV(+) MSM presented LGV related symptoms, while the other infected persons were either asymptomatic or presented no clear LGV symptoms. All samples revealed ompA sequences different from the L2/434 reference strain and from the L2b/144276, which is the most frequently described genotype during the recent LGV outbreak. CONCLUSIONS: The detection of 7 LGV specimens during 2007 in contrast with their absence over the previous 5 years. The LGV infected individuals do not seem to be related to any sexual networks of MSM, contrarily to those described in other European countries. Moreover, all Lisbon LGV specimens revealed unusual ompA sequences that differentiate them from the currently reported LGV infections in Europe. The results of the current study further justify an attentive surveillance of LGV strains infecting different populations and the study of their relation with clinical aspects and disease patterns.

Genital infection by Chlamydia trachomatis in Lisbon: prevalence and risk markers.

BACKGROUND: There is little information about the prevalence and risk markers for Chlamydia trachomatis infections in Portugal. OBJECTIVES: Our aim was to assess the prevalence of C. trachomatis genital infection and to study variables associated with this infection in a group of sexually active women aged < or =30 years living in the Lisbon area and to estimate the prevalence of C. trachomatis infection among partners of infected patients. METHODS: A systematic sample of women observed in general practice family planning and teenager clinics was collected. A questionnaire was administered, followed by a pelvic examination. A first-catch urine sample was taken for polymerase chain reaction (PCR) Amplicor assay. When a sample tested positive, the woman was invited to obtain a urine sample from her partner. Socio-demograhic, behavioural and clinical variables were studied and their association with the PCR Amplicor result was assessed. RESULTS: A total of 1108 women, aged between 14 and 30 years, were studied. Fifty-one women (4.6% of total sample) tested positive for C. trachomatis. The prevalence of infection was slightly higher in patients aged < or =19 years (5.3%) than in age groups 20-25 (4.8%) and 26-30 years (3.9%). African ethnicity was related to a higher percentage of infection than European ethnicity: 9.8% versus 3.8%, P= 0.0067. Use of condoms "sometimes/never" was associated with a higher prevalence of infection: 5.2% versus 2.3% in those responding "always/almost always" (P= 0.0447). An altered cervix was associated with a higher prevalence of infection: 7.3% versus 3.7% with a normal cervix (P= 0.0106). Urine samples were obtained from 16 partners of infected patients. Six partners (37.5%) tested positive for C. trachomatis. CONCLUSIONS: A 4.6% prevalence of C. trachomatis genital infection was found. African ethnicity, using condoms "sometimes/never" and an altered cervix were associated with C. trachomatis infection, but showed low positive predictive value for C. trachomatis infection. Younger age may be associated with a slight increase in risk. Contact tracing for diagnosis and treatment remains a difficult issue to approach effectively.