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Sex Transm Infect. 2014 Jun;90(4):269-74. doi: 10.1136/sextrans-2013-051401. Epub 2014 Mar 31.

Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case-control study in the U.K.

Author information

  • 1Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
  • 2Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.
  • 3Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK.
  • 4Guy's and St Thomas' NHS Foundation Trust, London, UK.
  • 5Brighton & Sussex University Hospitals NHS Trust, Claude Nicol Centre, Brighton, UK.
  • 6Jefferiss Wing Centre for Sexual Health, Imperial College Healthcare NHS Trust, London, UK.
  • 7Sandyford Sexual Health Services, Glasgow, UK.
  • 8Sexually Transmitted Bacterial Reference Laboratory, Public Health England, London, UK.

Abstract

OBJECTIVE:

Since 2003, over 2000 cases of lymphogranuloma venereum (LGV) have been diagnosed in the U.K. in men who have sex with men (MSM). Most cases present with proctitis, but there are limited data on how to differentiate clinically between LGV and other pathology. We analysed the clinical presentations of rectal LGV in MSM to identify clinical characteristics predictive of LGV proctitis and produced a clinical prediction model.

DESIGN:

A prospective multicentre case-control study was conducted at six U.K. hospitals from 2008 to 2010. Cases of rectal LGV were compared with controls with rectal symptoms but without LGV.

METHODS:

Data from 98 LGV cases and 81 controls were collected from patients and clinicians using computer-assisted self-interviews and clinical report forms. Univariate and multivariate logistic regression was used to compare symptoms and signs. Clinical prediction models for LGV were compared using receiver operating curves.

RESULTS:

Tenesmus, constipation, anal discharge and weight loss were significantly more common in cases than controls. In multivariate analysis, tenesmus and constipation alone were suggestive of LGV (OR 2.98, 95% CI 0.99 to 8.98 and 2.87, 95% CI 1.01 to 8.15, respectively) and that tenesmus alone or in combination with constipation was a significant predictor of LGV (OR 6.97, 95% CI 2.71 to 17.92). The best clinical prediction was having one or more of tenesmus, constipation and exudate on proctoscopy, with a sensitivity of 77% and specificity of 65%.

CONCLUSIONS:

This study indicates that tenesmus alone or in combination with constipation makes a diagnosis of LGV in MSM presenting with rectal symptoms more likely.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

KEYWORDS:

CLINICAL PREDICTORS; LYMPHOGRANULOMA VENEREUM; MSM; PROCTITIS; SEXUALLY TRANSMITTED INFECTION

PMID:
24687130
[PubMed - indexed for MEDLINE]
PMCID:
PMC4033117
Free PMC Article
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