Investigating the decline in Lymphogranuloma venereum diagnoses in men who have sex with men in the United Kingdom since 2016: an analysis of surveillance data
Hester Allen
A F , Rachel Pitt A , Megan Bardsley A , Christa Smolarchuk A , Ann Sullivan A , Hamish Mohammed A , Michelle Cole A , Helen Fifer A , Lesley Wallace B , Daniel Thomas C , Neil Irvine D , Kate Templeton E , Gwenda Hughes A and Ian Simms A
A National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.
B Health Protection Scotland, 5 Cadogan Street, Glasgow, G2 6QE, UK.
C Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4B, UK.
D Public Health Agency, Health and Social Care Northern Ireland, 12–22 Linenhall Street, Belfast, BT2 8BS, UK.
E Scottish Bacterial Sexually Transmitted Infections Reference Laboratory, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.
F Corresponding author. Email: hester.allen@phe.gov.uk
Sexual Health 17(4) 344-351 https://doi.org/10.1071/SH20001
Submitted: 3 January 2020 Accepted: 26 May 2020 Published: 7 August 2020
Journal compilation © CSIRO 2020 Open Access CC BY-NC-ND
Abstract
Background: Following an upward trajectory in Lymphogranuloma venereum (LGV) diagnoses in the UK from 2004 to 2016, with annual diagnoses increasing from 28 to 904, diagnoses fell to 641 in 2017; this was inconsistent with the upward trend in other bacterial sexually transmissible infections (STIs) between 2016 and 2017. An analysis of surveillance data from multiple sources to investigate the possible factors contributing to this decline in LGV was performed. Methods: LGV tests and diagnoses in the UK from 2004 to 2018 were captured through laboratory data from the LGV Reference Laboratories and laboratories conducting in-house LGV testing. These data and clinical diagnoses data from England were analysed alongside the national management guidelines issued over the course of the epidemic. Results: LGV diagnoses increased between 2004 and 2015 and then decreased between 2016 and 2018. LGV testing increased from 2010 to 2018 (2690–10 850). Test positivity halved between 2015 (14.8%, 929–6272) and 2018 (7.3%, 791–10 850). Peaks in LGV testing and diagnoses appeared to coincide with the publication of national LGV management guidelines and changes to clinical practice. The proportion of LGV diagnoses among HIV-positive men who have sex with men (MSM) fell between 2013 and 2018 (74–48%). Conclusions: The fall in diagnoses and positivity were likely due to increasing earlier clinical diagnosis and treatment. Changes to the national management guidelines, the clinical policy and practice of some larger clinics and potentially changes to the guidelines for the treatment of chlamydia broadened the scope of testing and increased testing in asymptomatic patients which, in combination, likely had a positive effect on the control of LGV infection.
Additional keywords: asymptomatic, Chlamydia trachomatis, LGV, MSM, sexually transmitted infections.
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