Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case–control study in the UK
Open accessAbstract
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.
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Genital HSV and LGV proctitis are more prevalent among persons with HIV infection.
“Genital HSV and LGV proctitis are more prevalent among persons with HIV infection (545,556,1382).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [545]
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- 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.
- Affiliations
- Chelsea and Westminster Hospital NHS Foundation Trust (GB)
- Imperial College London (GB)
- Central and North West London NHS Foundation Trust (GB)
- Guy's and St Thomas' NHS Foundation Trust (GB)
- Brighton and Sussex University Hospitals NHS Trust (GB)
- Imperial College Healthcare NHS Trust (GB)
- Public Health England (GB)
- Corresponding author
- Ward, H
- Venue
- Sexually Transmitted Infections
- Publisher
- BMJ
- Published
- 2014-03-31
- Volume
- 90
- Issue
- 4
- Pages
- 269-274
- ISSN
- 0007-134X (ISSN-L)
- 1368-4973
- 1472-3263
- PMC
- PMC4033117
- OpenAlex
- W2106007167
- Cited by
- 39
- References
- 31
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 2 · 2023: 1 · 2022: 6 · 2021: 4 · 2020: 3 · 2019: 3 · 2018: 1 · 2017: 4 · 2016: 6 · 2015: 2 · 2014: 2
- FWCI
- 3.80
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- Sexually Transmitted Infections (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Spiral (Imperial College London) (submittedVersion, cc-by)
- Funders
- National Institute for Health and Care Research
- Medical Research Council
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Keywords
- lymphogranuloma venereum, rectal infection, men who have sex with men, proctitis, tenesmus, constipation, clinical prediction model, differential diagnosis, weight loss, anal discharge
- MeSH terms
- Adult, Constipation, United Kingdom, Gastrointestinal Hemorrhage, Humans, Lymphogranuloma Venereum, Male, Middle Aged, Pain, Proctitis, Proctoscopy, Prospective Studies, Rectal Diseases, Sensitivity and Specificity, Weight Loss, HIV Infections, Multivariate Analysis, Logistic Models, Case-Control Studies, Homosexuality, Male
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