Lymphogranuloma Venereum (LGV) – an Emerging Infection Among Men Having Sex with Men in Israel

Background

Sexually transmitted diseases (STDs) incidence is dramatically increasing in the last decade, among them proctitis which resembles inflammatory bowel disease. In this work we present 18 patient which were diagnosed with STDs.

Aim

To characterized clinical, endoscopic and pathologic findings of 18 patients that were diagnosed with colorectal STD, and to characterize by molecular genotyping the Chlamydia trachomatis isolates.

Methods

This is a retrospective study. Clinical data was retrieved from medical records, Multi Locus Sequence Typing (MLST) analysis was performed for the five hypervariable genes hctB (CT046), CT058, CT144, CT172, pbpB (CT682). Biovar type was determined by ompA sequencing.

Results

18 patients originally identified as having STIs. All patients were MSM, mostly HIV-1 positive and had clinical and endoscopic findings compatible with IBD. C. trachomatis was positive in 14, of which 3 were of the LGV2b (ST58) biovar, Gonorrhea in 5, and syphilis in 4 cases. Between January 2018 and February 2019 17 cases of LGV were identified in the reference center, about half belong to the L2b biovar and the other to the emerging L2 and ST58 is the most dominant sequence type.

Conclusions:

This is the first report of biovars L2b and L2 in Israel. It is important to gain molecular typing since the treatment is different from the treatment of non LGV serovars. Biovar L2b that was first identified in the Netherlands in 2003, mainly among HIV-positive MSM and has spread globally to other industrialized countries.

Only a high index of suspicion, and rectal samples for STIs accompanied by molecular study for Chlamydia subtyping and correct diagnosis of LGV – L2b led to the right diagnosis, treatment and full recovery.