Lymphogranuloma venereum: screening must be systematic in case of proctitis

The Institute of Health recommends looking for lymphogranuloma venereum, whose emergence in France is confirmed in every male patient with signs of proctitis, in a study published in the Weekly Epidemiological Bulletin (BEH) on the theme of infections sexually transmitted diseases and HIV.

Actions to prevent sexually transmitted infections
InVS goes further in its recommendations, and proposes to set up a screening of some sexually transmitted infections, such as syphilis, HPV, HSV and gonorrhea in the clinical management of HIV-positive patients for HIV.

In their study of lymphogranuloma venereum (LGV), Magid Herida and colleagues point out that the STI is the subject of a European warning from the European Surveillance of STI (ESSTI) alleging fifteen cases grouped in Rotterdam. This alert led InVS to conduct investigations in France, which had identified 38 cases and track the clinical history of 14 of them.

A campaign to inform health care professionals most concerned (proctology, infectious disease specialists, dermatologists) was then business, and prevention activities were conducted in the community meeting places, involving the target population.

Finally, the sentinel surveillance system had been strengthened in January 2005, including the distribution of a self-administered questionnaire containing questions about sexual practices that could be at the origin of the LGV.

Confirmation of the emergence of LGV
Little use because of the low response rate, the data from this survey, however, does not allow to speculate on the transmission of LGV, the authors lament.

Only quantitative data collected by the centers participating in the monitoring could therefore be analyzed. They have reported 104 cases of rectal LGV in 2004 and 118 cases in 2005, a number certainly underestimated after InVS.

The shape of the epidemic curve thus refers to the emergence of rectal LGV in France since 2004 and a persistent infection in 2005, the authors conclude, adding that the cases are concentrated mainly in the Ile-de-France.

Those affected are exclusively men who have sex with men, HIV infection for the majority and also with another STI at diagnosis.

All patients were symptomatic with syndromes involving anal rectal discharge, anal or rectal ulceration.

The authors therefore recommend asking early diagnosis of HIV infection in order to avoid complications of untreated LGV and to interrupt the chain of transmission. They advocate the "testing and research of LGV among all male patient with signs of proctitis," all that "patients with rectal LGV are often co-infected with other bacteria."

According to them, "prevention campaigns stressing the need for safe sex remains essential, especially with the gay community."