Prevalence of lymphogranuloma venereum among anorectal Chlamydia trachomatis-positive MSM using pre-exposure prophylaxis for HIV.

OBJECTIVES: We evaluated the prevalence of lymphogranuloma venereum (LGV) in anorectal Chlamydia trachomatis-positive French men who have sex with men (MSM) using pre-exposure prophylaxis (PrEP) for HIV. Here, we describe the clinical, biological and behavioural characteristics of these patients. METHODS: Laboratories throughout French metropolitan areas performing routine testing for C. trachomatis sent positive anorectal specimens to the National Reference Centre for bacterial STIs for LGV real-time PCR targeting the pmpH gene. Identification of the C. trachomatis genovar was performed by ompA gene sequencing. For each patient, clinical, biological and sexual behaviour data were collected after obtaining written informed consent. RESULTS: In 2017, 486 anorectal C. trachomatis-positive specimens from MSM PrEP users were analysed. A strain of genovar L was detected in 91 cases (18.7%). Patients with LGV were significantly more symptomatic, had more sexual partners and more concurrent syphilis compared with their non-LGV counterparts. OmpA gene sequencing, successful in two-thirds of anorectal C. trachomatis-positive specimens, showed that the LGV cases were mainly of variant L2b (n=33), followed by genovar L2 (n=27) and genetic L2b ompA variants (n=16). In 11 cases, the results indicated the occurrence of genetic exchange between L and non-L genovars. CONCLUSIONS: LGV was diagnosed in 18.7% of anorectal C. trachomatis-positive specimens from French MSM using PrEP. LGV testing should be carried out for MSM diagnosed with chlamydia and with a large number of sexual partners, high-risk practices and anorectal symptoms. These patients should be presumptively treated as having LGV. This is the first surveillance study of LGV among MSM PrEP users and monitoring should continue.

What do young women think about having a chlamydia test? Views of women who tested positive compared with women who tested negative.

OBJECTIVE: To determine young women's experience of having a chlamydia (Chlamydia trachomatis) test as part of a chlamydia incidence study, and to determine how women who tested positive during the study experienced having a test compared with the experience of women who always tested negative. METHODS: Women in an Australian chlamydia incidence study were tested at 3- to 6-monthly intervals during a 12-month period. At the final stage of the study, the women completed a questionnaire about how they felt about testing positive or how they anticipated they might feel about testing positive if they only tested negative. Questions about future sexual behaviour and testing were included. RESULTS: The questionnaire was completed by 872 out of 1116 (78%) women, including 67 women who tested positive. Many women (75%) felt anxious when having a chlamydia test but women who tested positive were less concerned about their future health (61% v. 81%, P<0.01), were less concerned about their partner's reactions (62% v. 79%, P<0.01) and were more likely to discuss their diagnosis with other people (57% v. 36%, P<0.01). CONCLUSIONS: The participants in the study were pleased to have been tested and supported a screening program. Women who tested positive were less concerned about having a positive result than women who tested negative anticipated they might be. IMPLICATIONS: Clinicians need to be aware that having a chlamydia test can cause anxiety in young women and for a screening program to be successful, this must be addressed.

Psychosocial determinants of the intention to use a chlamydia home self-test: awareness of risk behaviour and test accuracy are important elements of educational interventions.

BACKGROUND: The aim of the present study was to investigate the association between psychosocial variables and the intention to use a chlamydia (Chlamydia trachomatis) home self-test, to enable information to be tailored to the target population. METHODS: A cross-sectional survey was carried out among an internet panel. A questionnaire was sent to a sample of 227 panelists in October 2006. A multiple linear regression analysis was conducted to assess the predictive value of the psychosocial factors for the intention to test. RESULTS: The response rate was 88% (n=200). Respondents with higher intentions to use a home self-test were younger, perceived themselves to be more susceptible to chlamydia, had more personal experience with chlamydia, felt a stronger moral obligation to do a test and had a higher level of response efficacy than those with lower intentions. CONCLUSIONS: This study provides topics for educational interventions aimed at encouraging chlamydia testing in general, and at developing a more effective use of home self-test. Awareness of personal behaviour and information about the probability of false positive and false negative test results with home self-tests should be elements of these interventions.

Persistent high-risk sexual behaviour in men who have sex with men after symptomatic lymphogranuloma venereum proctitis.

In this brief paper, we report persistent high-risk sexual behaviour in a group of men who have sex with men (MSM) after symptomatic lymphogranuloma venereum (LGV) proctitis. Patient records were retrospectively studied and the number of newly acquired sexually transmitted disease (STD) was investigated. It was concluded that a high number of MSM (65%) contracted an STD relatively shortly after the diagnosis of LGV proctitis.