Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case–control study in the UK. (31st March 2014)

• Record Type: Journal Article
• Authors: Pallawela, S N S; Sullivan, A K; Macdonald, N; French, P; White, J; Dean, G; Smith, A; Winter, A J; Mandalia, S; Alexander, S; Ison, C; Ward, H
• Other Names: Hadley Wendy author non-byline.; Benzie Andrew author non-byline.; Hodson Lydia author non-byline.; Chopin Mathias author non-byline.; Schepers Claire author non-byline.; Halley Susannah author non-byline.; Bradshaw Daniel author non-byline.; Gedela Keerti author non-byline.; Price Huw author non-byline.; Azwa Alex author non-byline.; Trayno Donal author non-byline.; Seaton Gary author non-byline.
• Is Part Of: Sexually transmitted infections. Volume 90:issue 4(2014)
• Page Start: 269
• Page End: 274
• Publication Date: 2014-03-31
• Subjects: LYMPHOGRANULOMA VENEREUM -- MSM -- PROCTITIS -- SEXUALLY TRANSMITTED INFECTION -- CLINICAL PREDICTORS; Sexually transmitted diseases -- Periodicals; HIV infections -- Periodicals; 616.951005
• DOI: 10.1136/sextrans-2013-051401
• Languages: English
• ISSNs: 1368-4973

Abstract

Abstract : Objective: Since 2003, over 2000 cases of lymphogranuloma venereum (LGV) have been diagnosed in the UK 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 UK 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.