The re-emergence of lymphogranuloma venereum in Europe, a Maltese case
K Muscat, V Padovese, Genito-Urinary Medicine Clinic, Mater Dei Hospital, Malta
Lymphogranuloma venereum (LGV) is a sexually transmitted infection (STI) caused by Chlamydia trachomatis serovars L1-L3, L2 being the most common. Prior to 2003, LGV was considered a tropical disease and thus, generally sporadic and ‘imported’ into Europe from endemic countries. In recent years LGV has been consistently on the rise, especially in HIV positive men who have sex with men (MSM) with high-risk sexual behaviour, and several EU countries have reported an increase in the incidence of LGV. Current guidelines recommend screening all MSM who give a history of receptive anal intercourse in the previous 6 months for anorectal Chlamydia trachomatis infection. MSM who result positive for anorectal infection, should subsequently be screened for LGV. Approximately 25% of LGV infections can be asymptomatic and may represent a missed pool of undiagnosed LGV. In April 2016, the GU Clinic in Malta started screening all MSM who test positive for rectal Chlamydia trachomatis for LGV, irrespective of HIV status. The test consists of a rectal PCR swab for the detection of L1, L2, L3 Chlamydia trachomatis serovars. To date, there have been 60 documented diagnoses of rectal Chlamydia trachomatis, with one patient testing positive for LGV, serovar L2. This is the first documented LGV case in Malta in a HIV negative MSM on Pre-Exposure Prophylaxis (PrEP). As with other STIs, education on prevention, a high index of suspicion and early diagnosis and treatment are essential to prevent late, irreversible complications such as anal fistulae and strictures. From a public health perspective, surveillance and notification of LGV cases are essential to provide a clearer picture on its emergence in Europe.