Delayed diagnosis of lymphogranuloma venereum in a hospital setting - a retrospective observational study.

OBJECTIVE: The incidence of lymphogranuloma venereum (LGV) in Europe is increasing. However, diagnosing LGV in a hospital setting is rare. We analysed the diagnostic process and clinical characteristics of patients with LGV in a hospital setting. DESIGN AND SETTING: A retrospective observational study conducted in a teaching hospital in Amsterdam, The Netherlands. All adult patients with LGV between November 2010 and February 2019 were included. Clinical data were retrieved from electronic patient records. RESULTS: 40 patients were included. 90% of patients were men who have sex with men (MSM) and 62,5% were HIV positive. The most common presenting symptoms were rectal bleeding (47,5%), anal symptoms (30%) and change in bowel habits (25%). The mean time from first consultation to diagnosis was 28 days (range: 0 to 332, median 16,5 days). Diagnostic delay was increased by clinical presentation (ie anogenital syndrome) and the number of specialists involved. Diagnostic procedures not leading to the diagnosis were performed in 98% of cases. CONCLUSION: To prevent late complications, unnecessary diagnostic procedures and further transmission, early testing for LGV should be incorporated in the work-up of every patient reporting MSM-activity presenting with anorectal symptoms or inguinal lymphadenopathy.

Clinical signs, diagnostics and successful treatment of a myocarditis in an adult chimpanzee (Pan troglodytes).

A chimpanzee (Pan troglodytes) was presented with lethargic behaviour. Echocardiography and abnormal cardiac and inflammatory biomarkers revealed a myocarditis. The animal fully recovered after prolonged treatment with losartan and carvedilol. This is the first report of the diagnosis and successful treatment of myocarditis in this species.

High performance and acceptability of self-collected rectal swabs for diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae in men who have sex with men and women.

BACKGROUND: Identification of sexually transmitted infections (STI) is limited by the infrequent assessment of rectal STI. This study assesses usability of self-collected rectal swabs (SRS) in diagnosing rectal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). METHODS: In 2006 to 2007, clients of the Amsterdam and South Limburg STI outpatient clinics reporting receptive anal intercourse were asked to fill out a questionnaire and provide SRS. A standard provider-collected rectal swab (PRS) was also taken, and both were tested for CT and NG by a nucleic acid amplification tests. SRS performance was compared with PRS as to agreement, sensitivity, and specificity. RESULTS: Prevalence of rectal CT was 11% among the 1458 MSM and 9% among the 936 women. Rectal NG prevalence was 7% and 2%. In 98% of both MSM and women, SRS and PRS yielded concordant CT test results, for NG agreement was 98% for MSM and 99.4% for women. SRS performance for CT and NG diagnosis was good in both groups and was comparable for both study regions. Slightly more (57% of MSM, 62% of women) preferred SRS to PRS or had no preference; 97% would visit the STI clinic again if SRS was standard practice. CONCLUSIONS: Because anal sex is a common practice for MSM and women, and anal STI are frequently present, rectal screening should be an essential part of an STI consultation. SRS is a feasible, valid, and acceptable alternative for MSM and women attending STI clinics, and hence should be considered for other settings as well.

Trends in hepatitis A, B, and shigellosis compared with gonorrhea and syphilis in men who have sex with men in Amsterdam, 1992-2006.

BACKGROUND: Since the mid-1990s, sexually transmitted infections (STIs) among men who have sex with men (MSM) have increased and appear to be related to more risky sexual behavior. We compare trends in hepatitis A, acute hepatitis B, and shigellosis with the trends of gonorrhea and infectious syphilis in Amsterdam MSM more than a period of 15 years. METHODS: We used data of all reported hepatitis A, acute hepatitis B, and shigellosis, and from all patients newly diagnosed with gonorrhea and infectious syphilis who visited the Public Health Service STI outpatient department in Amsterdam between January 1, 1992 and December 31, 2006. RESULTS: Hepatitis A incidence remained unchanged in MSM (mean 0.97 per 1000 MSM, range 0.04-2.27), who had 21% of all 1697 infections. Hepatitis B likewise remained unchanged in MSM (mean 0.47 per 1000 MSM, range 0.19-0.77), who had 41% of all 448 infections. Most shigellosis is travel-related (657/974), and 16% of the infections occurred in MSM. Its incidence dropped in general, but not in MSM. Both gonorrhea and infectious syphilis in MSM show a steep increase, mainly after 1998. DISCUSSION: Hepatitis A, B, and shigellosis do not follow the rising trends of conventional STI in MSM, which are believed to result from increased risky sexual behavior. This disparity in trends implies differences in transmission dynamics. Recent molecular epidemiologic studies suggest that clustered transmission in social MSM networks plays a major role.

Online-mediated syphilis testing: feasibility, efficacy, and usage.

OBJECTIVES: To determine the feasibility and efficacy of an online-mediated syphilis screening among men who have sex with men. METHODS: We developed a Web site that offered information about syphilis and motivated users to download a referral letter with which they could test for syphilis in a nonclinical setting. A week after the blood test, participants could retrieve their results online. To assess the feasibility and efficacy of the Web site we followed the users through the online procedure and compared the percentage of syphilis infected men detected online with those diagnosed at the local sexually transmitted infection (STI) clinic, during the same time frame. The trial was divided into an initial period of online advertising (4 months) and no advertising (11 months) to examine how advertisements affect usage. RESULTS: During 15 months, 898 visitors downloaded a referral letter. Of these, 93 (10%) men tested and 96% (90 of 93) obtained their test results online. Through the Web site we found a significantly higher percentage of men who needed treatment for syphilis compared with the STI clinic (50% online vs. 24% STI clinic, P <0.01). Of the Online users who tested positive 33% (3 of 10) had never visited the STI clinic before. In the bannered period there was a monthly average of 15 testers compared with 3 per month in the nonbannered period. CONCLUSION: Online-mediated testing for syphilis is feasible and was more successful in detecting men who have sex with men with an early or late syphilis infection than standard procedures. However, longer promotion periods are needed to generate more usage of the online service.

Effectiveness of a risk-based visitor-prioritizing system at a sexually transmitted infection outpatient clinic.

OBJECTIVE: The objective of this study was to study the efficacy/effectiveness of a risk-based visitor-prioritizing system at a sexually transmitted infection (STI) clinic aimed to improve screening capacity by providing tailored service. STUDY DESIGN: In April 2004, a prioritizing system was implemented that classifies visitors as high or low risk depending on reported sexual behavior and previous STI events. The high- and low-risk groups are assigned to standard and short screening protocols, respectively. Both protocols include diagnostic testing for syphilis, urogenital gonorrhea, chlamydia, and optional for HIV. To assess the effectiveness of the system, differences in prevalence of STI diagnoses in the standard and short protocol were analyzed by chi test. RESULTS: In total, 14,391 visitors (64%) received standard screening and 8,056 visitors (36%) received short screening. The STI prevalence in both groups was 18.1% and 7.6%, respectively (P <0.001); prevalence of HIV was 1.8% and 0.3%, respectively (P <0.001). The sensitivity of the prioritizing system was 74%. Specificity was substantially lower (42%). CONCLUSIONS: This prioritizing system is effective in differentiating between visitors at high and low risk for STI, contributing to provision of tailored STI service, increasing efficiency, and client access to STI service.