Unprotected receptive anal sex is the key risk factor for rectal LGV (lymphogranuloma venereum) infections in gay and other men who have sex with men (MSM), UK researchers report. Their case-controlled study published in the online edition of Sexually Transmitted Infections also showed that 89% of people with LGV were HIV positive. Fisting and drug use were also identified as risk factors for infection.
“Campaigns to raise awareness of LGV and of the symptoms among gay men, particularly HIV-positive men, should be updated and maintained,” write the authors. “Sexual health clinics should identify men at risk, encourage frequent STI screening, provide adequate treatment and contact tracing, and offer appropriate support to minimise the risks associated with sexual behaviour and substance use.”
LGV is a bacterial STI caused by strains of Chlamydia. It is associated with invasive, ulcerative disease and can be cured with a 21-day course of antibiotic therapy.
There is an ongoing epidemic of LGV among gay men in the UK. Although the first cases were recorded as long ago as 2003, there is still uncertainty about its risk factors.
A team of UK investigators therefore designed a case-controlled study involving six treatment centres in Brighton, Glasgow and London, all with high LGV caseloads. The study population was restricted to men reporting sex with other men.
The cases (n = 90) were men with confirmed rectal LGV infection. There were two types of controls: men with rectal symptoms possibly associated with LGV (n = 74) and asymptomatic men without such symptoms (n = 69). Participants were recruited between August 2008 and December 2010.
Study participants provided details of their HIV infection status, recent sexual behaviour and use of recreational drugs.
Participants had a median age of 39 years. HIV prevalence was significantly higher among the cases (89%), compared to both the symptomatic (48%) and asymptomatic (68%) controls.