Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 22, Number 10—October 2016
Research

Systematic Review and Meta-Analysis of Doxycycline Efficacy for Rectal Lymphogranuloma Venereum in Men Who Have Sex with Men

Charussri Leeyaphan, Jason J. Ong, Eric P.F. Chow, Fabian Y.S. Kong, Jane S. Hocking, Melanie Bissessor, Christopher K. Fairley, and Marcus Y. ChenComments to Author 
Author affiliations: Mahidol University, Bangkok, Thailand (C. Leeyaphan); Alfred Health, Melbourne, Victoria, Australia (C. Leeyaphan, J.J. Ong, E.P.F. Chow, M. Bissessor, C.K. Fairley, M. Chen); Monash University, Melbourne (J.J. Ong, E.P.F. Chow, C.K. Fairley, M. Chen); University of Melbourne, Melbourne (F.Y.S. Kong, J.S. Hocking)

Main Article

Table 1

Studies from 2006 to 2015 reporting the efficacy of 100 mg doxycycline twice daily for 21 days for the treatment of rectal LGV in men who have sex with men*

Ref. Study type Serovar No. men tested positive and treated for LGV/no. retested after treatment No. symptomatic/no. total (%) No. HIV-positive/no. total (%) Method for retesting Time from treatment to retesting No. negative repeat test results/no. repeat tests (% negative; 95% CI)
(25)
 RS/PS
 L2
 21/21
 18/21 (86)
 13/21 (62)
 Cobas Amplicor Analyzer†
 NS
 21/21 (100; 85–100)
(17)
 PS
 L
 20/17
 NS
 NS
 Cobas Amplicor Analyzer†
 3 wk
 17/17 (100; 82–100)
(26)
 RS
 L
 55/19
 59/63 (94)
 52/63 (82)
 BD ProbeTec ET System‡
 3 mo
 19/19 (100; 83–100)§
(28)
 RS
 L
 70/70¶
 80/99 (81)
 78/99 (79)
 BD ProbeTec ET System‡
 <6 mo
 68/69 (99; 92–100)¶
(29)
 RS
 L2b
 20/20#
 20/20 (100)
 18/25 (72)
 BD ProbeTec ET System‡
 3 mo
 19/20 (95; 76–99)#
(30)
 RS
 L
 80/43
 71/83 (85)
 69/83 (83)
 APTIMA Combo 2 assay**
 6 wk
 42/43 (97; 88–100)††
(27)
 PS
 L2
 13/13
 13/13 (100)
 9/13 (69)
 Versant CT/GC DNA 1.0 assay‡‡
 3 mo
 13/13 (100; 77–100)
(3)
 PS
 L2, L2b
 53/53§§
 73/82 (89)
 66/82 (80)
 Abbott RealTime CT/NG assay¶¶, BD ProbeTec ET System‡
 NS
 51/53 (96; 87–99)§§
(31) PS L 28/27 28/28 (100) 27/28 (96) Real-time multiplex PCR 3 wk 27/27 (100; 88–100)##

*LGV, lymphogranuloma venereum; NS, not specified; PS, prospective; ref., reference; RS, retrospective; RS/PS, retrospective and prospective.
†Roche, Basel, Switzerland.
‡Becton Dickinson Microbiology Systems, Sparks, MD, USA.
§S.C. Hill, St. Mary's Hospital, London, UK, pers. comm., 2016 Apr 28.
¶Seventy men treated for rectal LGV underwent repeat testing; 1 had an equivocal result and was excluded from further analyses (S. Pallawela, Royal Berkshire Hospital, Reading, UK, pers. comm., 2016 Apr 28).
#M. Bissessor, Melbourne Sexual Health Centre, Carlton, Victoria, Australia, pers. comm., 2016 Apr 1.
**Gen-Probe Inc., San Diego, CA, USA.
††A. Garner, Stockport NHS Foundation Trust, Stockport, UK, pers. comm., 2016 May 26.
‡‡Siemens Healthcare Diagnostics, Terrytown, NY, USA,
§§J.C. Galan, Hospital Ramon y Cajal, Madrid, Spain, pers. comm., 2016 May 16.
¶¶Abbott Laboratories, Des Plaines, IL, USA
##J.L. Blanco, University of Barcelona, Barcelona, Spain, pers. comm., 2016 May 10.

Main Article

References
  1. Macdonald  N, Sullivan  AK, French  P, White  JA, Dean  G, Smith  A, Risk factors for rectal lymphogranuloma venereum in gay men: results of a multicentre case-control study in the U.K. Sex Transm Infect. 2014;90:262–8.DOIPubMedGoogle Scholar
  2. Hughes  G, Alexander  S, Simms  I, Conti  S, Ward  H, Powers  C, ; LGV Incident Group. Lymphogranuloma venereum diagnoses among men who have sex with men in the U.K.: interpreting a cross-sectional study using an epidemic phase-specific framework. Sex Transm Infect. 2013;89:542–7.DOIPubMedGoogle Scholar
  3. Rodríguez-Domínguez  M, Puerta  T, Menéndez  B, González-Alba  JM, Rodríguez  C, Hellín  T, Clinical and epidemiological characterization of a lymphogranuloma venereum outbreak in Madrid, Spain: co-circulation of two variants. Clin Microbiol Infect. 2014;20:219–25.DOIPubMedGoogle Scholar
  4. Haar  K, Dudareva-Vizule  S, Wisplinghoff  H, Wisplinghoff  F, Sailer  A, Jansen  K, Lymphogranuloma venereum in men screened for pharyngeal and rectal infection, Germany. Emerg Infect Dis. 2013;19:488–92.DOIPubMedGoogle Scholar
  5. de Vries  HJ, Zingoni  A, Kreuter  A, Moi  H, White  JA; European Branch of the International Union against Sexually Transmitted Infections; European Academy of Dermatology and Venereology; European Dermatology Forum; European Society of Clinical Microbiology and Infectious Diseases; Union of European Medical Specialists; European Centre for Disease Prevention and Control; European Office of the World Health Organisation. 2013 European guideline on the management of lymphogranuloma venereum. J Eur Acad Dermatol Venereol. 2015;29:1–6.DOIPubMedGoogle Scholar
  6. White  J, O’Farrell  N, Daniels  D; British Association for Sexual Health and HIV. 2013 UK National Guideline for the management of lymphogranuloma venereum: Clinical Effectiveness Group of the British Association for Sexual Health and HIV (CEG/BASHH) Guideline development group. Int J STD AIDS. 2013;24:593–601.DOIPubMedGoogle Scholar
  7. Saxon  C, Hughes  G, Ison  C; UK LGV Case-Finding Group. Asymptomatic lymphogranuloma venereum in men who have sex with men, United Kingdom. Emerg Infect Dis. 2016;22:112–6.DOIPubMedGoogle Scholar
  8. Bissessor  M, Tabrizi  SN, Bradshaw  CS, Fairley  CK, Hocking  JS, Garland  SM, The contribution of Mycoplasma genitalium to the aetiology of sexually acquired infectious proctitis in men who have sex with men. Clin Microbiol Infect. 2016;22:260–5.DOIPubMedGoogle Scholar
  9. Bissessor  M, Fairley  CK, Read  T, Denham  I, Bradshaw  C, Chen  M. The etiology of infectious proctitis in men who have sex with men differs according to HIV status. Sex Transm Dis. 2013;40:768–70.DOIPubMedGoogle Scholar
  10. Van der Bij  AK, Spaargaren  J, Morré  SA, Fennema  HS, Mindel  A, Coutinho  RA, Diagnostic and clinical implications of anorectal lymphogranuloma venereum in men who have sex with men: a retrospective case-control study. Clin Infect Dis. 2006;42:186–94.DOIPubMedGoogle Scholar
  11. Pallawela  SN, Sullivan  AK, Macdonald  N, French  P, White  J, Dean  G, Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case-control study in the U.K. Sex Transm Infect. 2014;90:269–74.DOIPubMedGoogle Scholar
  12. Stoner  BP, Cohen  SE. Lymphogranuloma venereum 2015: clinical presentation, diagnosis, and treatment. Clin Infect Dis. 2015;61(Suppl 8):S865–73.DOIPubMedGoogle Scholar
  13. de Vrieze  NH, de Vries  HJ. Lymphogranuloma venereum among men who have sex with men. An epidemiological and clinical review. Expert Rev Anti Infect Ther. 2014;12:697–704.DOIPubMedGoogle Scholar
  14. Greaves  AB, Hilleman  MR, Taggart  SR, Bankhead  AB, Feld  M. Chemotherapy in bubonic lymphogranuloma venereum: a clinical and serological evaluation. Bull World Health Organ. 1957;16:277–89.PubMedGoogle Scholar
  15. Workowski  KA, Bolan  GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(RR-03):1–137.PubMedGoogle Scholar
  16. McLean  CA, Stoner  BP, Workowski  KA. Treatment of lymphogranuloma venereum. Clin Infect Dis. 2007;44(Suppl 3):S147–52.DOIPubMedGoogle Scholar
  17. de Vries  HJC, Smelov  V, Middelburg  JG, Pleijster  J, Speksnijder  AG, Morré  SA. Delayed microbial cure of lymphogranuloma venereum proctitis with doxycycline treatment. Clin Infect Dis. 2009;48:e53–6.DOIPubMedGoogle Scholar
  18. Méchaï  F, de Barbeyrac  B, Aoun  O, Mérens  A, Imbert  P, Rapp  C. Doxycycline failure in lymphogranuloma venereum. Sex Transm Infect. 2010;86:278–9.DOIPubMedGoogle Scholar
  19. Castro  R, Baptista  T, Vale  A, Nunes  H, Prieto  E, Araújo  C, Lymphogranuloma venereum serovar L2b in Portugal. Int J STD AIDS. 2010;21:265–6.DOIPubMedGoogle Scholar
  20. Vall-Mayans  M, Isaksson  J, Caballero  E, Sallés  B, Herrmann  B. Bubonic lymphogranuloma venereum with multidrug treatment failure. Int J STD AIDS. 2014;25:306–8.DOIPubMedGoogle Scholar
  21. Oud  EV, de Vrieze  NH, de Meij  A, de Vries  HJ. Pitfalls in the diagnosis and management of inguinal lymphogranuloma venereum: important lessons from a case series. Sex Transm Infect. 2014;90:279–82.DOIPubMedGoogle Scholar
  22. Higgins  JP, Thompson  SG, Deeks  JJ, Altman  DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.DOIPubMedGoogle Scholar
  23. Sterne  JA, Sutton  AJ, Ioannidis  JP, Terrin  N, Jones  DR, Lau  J, Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 2011;343:d4002.DOIPubMedGoogle Scholar
  24. Sanderson  S, Tatt  ID, Higgins  JP. Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliography. Int J Epidemiol. 2007;36:666–76.DOIPubMedGoogle Scholar
  25. Waalboer  R, van der Snoek  EM, van der Meijden  WI, Mulder  PG, Ossewaarde  JM. Analysis of rectal Chlamydia trachomatis serovar distribution including L2 (lymphogranuloma venereum) at the Erasmus MC STI clinic, Rotterdam. Sex Transm Infect. 2006;82:207–11.DOIPubMedGoogle Scholar
  26. Hill  SC, Hodson  L, Smith  A. An audit on the management of lymphogranuloma venereum in a sexual health clinic in London, UK. Int J STD AIDS. 2010;21:772–6.DOIPubMedGoogle Scholar
  27. Foschi  C, Marangoni  A, D’Antuono  A, Nardini  P, Compri  M, Bellavista  S, Prevalence and predictors of Lymphogranuloma venereum in a high risk population attending a STD outpatients clinic in Italy. BMC Res Notes. 2014;7:225.DOIPubMedGoogle Scholar
  28. Pallawela  S, Elgalib  A, Almeida  M, Annan  T, Alexander  S, Tong  CYW, Three weeks of doxycycline is an effective treatment for rectal lymphogranuloma venereum. HIV Med. 2010;11(Suppl 1):75–6.
  29. Bissessor  M. P1-S2.39: characteristics of lymphogranuloma venereum (LGV) infection among homosexual men in Melbourne. Sex Transm Infect. 2011;87:A139 .DOIGoogle Scholar
  30. Vas  A, Leighton  J, Saxon  C, Lebar  D, Stott  C, Ahmad  S, Audit of the clinical management of lymphogranuloma venereum in three inner-city genitourinary medicine clinics. Int J STD AIDS. 2013;24(Suppl 5):30.
  31. Blanco  JL, Fuertes  I, Bosch  J, Gonzalez  A, Vergara  A, Camp  R, Effective treatment of lymphogranuloma venereum (LGV) with 1g azithromycin administered weekly for 3 weeks in an HIV-infected population [CROI abstract 845]. Top Antivir Med. 2015;23(e-1):384.
  32. Batteiger  BE, Tu  W, Ofner  S, Van Der Pol  B, Stothard  DR, Orr  DP, Repeated Chlamydia trachomatis genital infections in adolescent women. J Infect Dis. 2010;201:42–51.DOIPubMedGoogle Scholar
  33. Kong  FY, Tabrizi  SN, Fairley  CK, Vodstrcil  LA, Huston  WM, Chen  M, The efficacy of azithromycin and doxycycline for the treatment of rectal chlamydia infection: a systematic review and meta-analysis. J Antimicrob Chemother. 2015;70:1290–7.DOIPubMedGoogle Scholar
  34. Chen  MY, Read  TRH, Leslie  DE, Bissessor  M. A couplet: a case of anal ulceration and another of inguinal swelling. Med J Aust. 2011;195:47–8.PubMedGoogle Scholar
  35. Somboonna  N, Wan  R, Ojcius  DM, Pettengill  MA, Joseph  SJ, Chang  A, Hypervirulent Chlamydia trachomatis clinical strain is a recombinant between lymphogranuloma venereum (L(2)) and D lineages. MBio. 2011;2:e00045–11. DOIPubMedGoogle Scholar
  36. Harris  SR, Clarke  IN, Seth-Smith  HMB, Solomon  AW, Cutcliffe  LT, Marsh  P, Whole-genome analysis of diverse Chlamydia trachomatis strains identifies phylogenetic relationships masked by current clinical typing. Nat Genet. 2012;44:413–9, S1.DOIPubMedGoogle Scholar
  37. de Vries  HJC, Schim van der Loeff  MF, Bruisten  SM. High-resolution typing of Chlamydia trachomatis: epidemiological and clinical uses. Curr Opin Infect Dis. 2015;28:61–71.DOIPubMedGoogle Scholar
  38. Dukers-Muijrers  NH, Speksnijder  AG, Morré  SA, Wolffs  PF, van der Sande  MA, Brink  AA, Detection of anorectal and cervicovaginal Chlamydia trachomatis infections following azithromycin treatment: prospective cohort study with multiple time-sequential measures of rRNA, DNA, quantitative load and symptoms. PLoS One. 2013;8:e81236.DOIPubMedGoogle Scholar

Main Article

Page created: September 20, 2016
Page updated: September 20, 2016
Page reviewed: September 20, 2016
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external