Characteristics of rectal chlamydia among men who have sex with men in southern Taiwan, 2020–2022: An emerging threat of rectal lymphogranuloma venereum L2b

BackgroundThe prevalence of rectal chlamydia among men who have sex with men (MSM) without human deficiency virus infection (non-HIV) remains uncertain in Taiwan, and rectal lymphogranuloma venereum (LGV) among MSM has never been reported in the Far East.Material and methodsFrom January 2020 to April 2022, MSM coming for anonymous voluntary counseling and testing, for pre-exposure prophylaxis, and for antiretroviral therapy were enrolled. All participants submitted his fecal samples and completed a QR-code questionnaire. Medical records of those who took regular medical visits for HIV were recorded. Multiplex polymerase chain reaction (PCR) was performed for all fecal samples, and ompA gene sequencing was therefore performed for each Chlamydia-positive fecal sample.ResultsAmong 341 MSM during 2020–2022 in southern Taiwan, 21 (6.2%) had rectal chlamydia infection. Risk factors of rectal chlamydia included co-infection with rectal gonorrhea (adjusted odds ratio [AOR] 6.78, 95% confidence interval [CI] 1.44–31.91, P = 0.015) and multiple sexual partners (AOR 1.373, 95% CI 1.002–1.882, P = 0.048). Further ompA gene sequencing from 19 Chlamydia-positive fecal samples revealed that the prevalent genotypes or genovariants were Da (26.3%) and L2b (26.3%), followed by B (21.1%), J (14.3%), and G (9.5%). All cases of rectal LGV genovariant L2b presented as acute proctitis with diarrhea, anal pain, or discharge and were treated successfully with prolonged treatment of doxycycline.ConclusionsRectal gonorrhea and multiple sexual partners are risk factors for rectal chlamydia. Clinicians in Taiwan should be aware of the emerging threat of rectal LGV among MSM with acute proctitis.     

Infecciones por Chlamydia trachomatis (incluye linfogranuloma venéreo) y Mycoplasma genitalium

Sexually transmitted infections caused by Chlamydia trachomatis, including lymphogranuloma venereum and Mycoplasma genitalium have increased in last decade. This epidemiological scenario presents new challenges in order to improve and strengthen our control and prevention strategies. The routine clinical diagnosis of urethritis and cervicitis must be combined with the active search for the causal agent in men with symptoms of dysuria or proctitis, and in women with pelvic inflammatory disease. We should also include sexually transmitted infections screening in asymptomatic patients with sexual risk behaviours or sexual contact with patients diagnosed with an sexually transmitted infection. The microbiological diagnosis must be based on molecular techniques capable of detecting Chlamydia trachomatis (discriminating between L genotypes associated with lymphogranuloma venereum and other genotypes) and Mycoplasma genitalium (ideally including the identification of macrolide-resistant strains). A faster and specific diagnosis will allow for a targeted treatment with a suitable antibiotic regimen. We also recommend including contact tracing of sexual partners and, occasionally, a cure test. Finally, sexually transmitted infection screening must be widely implemented in those population groups with a high prevalence of sexually transmitted infections.     

性病性淋巴肉芽肿的研究进展

性病性淋巴肉芽肿是由L型沙眼衣原体引起的一种经典的性传播疾病.临床上以生殖器溃疡、腹股沟淋巴结病或生殖器肛门直肠综合征为主要特征,病程慢性.中国仅有散发病例报道.近年在欧美国家的男男同性性行为者中有性病性淋巴肉芽肿暴发流行,其流行菌株主要是L2b型沙眼衣原体.男男同性性行为者人群中的性病性淋巴肉芽肿多为有症状的直肠炎,有多性伴或高危性行为,常合并HIV感染、其他性传播疾病和血源性疾病.分子生物学检测技术在性病性淋巴肉芽肿的诊断与鉴定中发挥着重要的作用.     

嗜酸性淋巴肉芽肿7例放疗效果分析

目的：了解放射治疗７例嗜酸性淋巴肉芽肿的疗效。方法：采用单纯放疗,总剂量ＤＴ２０～５０Ｇｙ,分次剂量ＤＴ１．５～２．５Ｇｙ。结果：６例于治疗结束前肿瘤完全消失,１例于治疗后１年完全消失,随访３～９年,均无瘤生存。结论：单纯放疗是治愈嗜酸性淋巴肉芽肿的有效方法和首选途径。     

男男性行为人群性病性淋巴肉芽肿的流行状况及其研究进展

性病性淋巴肉芽肿是性传播疾病之一。20世纪,此病在绝大多数发达国家已经得到有效的控制。然而,2003年底以来,此病在欧美等发达国家重新流行,并且在男男性行为人群中不断发生散发、爆发或流行。在男男性行为人群中,其流行特征表现为以沙眼衣原体L2型感染为主,主要发生在艾滋病病毒(HIV)感染者,且有特征性的直肠炎临床表现。目前性病淋巴肉芽肿的实验室诊断以实时聚合酶链反应(PCR)为主要手段,强力霉素仍作为治疗的首选药物。