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CORRESPONDENCE
Year : 2019  |  Volume : 37  |  Issue : 4  |  Page : 595-597
 

Under diagnosis of the lymphogranuloma venereum serovars in the Indian population


1 Department of Microbiology, Government Doon Medical College, Dehradun, Uttarakhand, India
2 Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India

Date of Submission14-Dec-2019
Date of Acceptance19-Mar-2020
Date of Web Publication18-May-2020

Correspondence Address:
Benu Dhawan
Department of Microbiology, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmm.IJMM_19_475

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How to cite this article:
Juyal D, Rawre J, Dhawan B. Under diagnosis of the lymphogranuloma venereum serovars in the Indian population. Indian J Med Microbiol 2019;37:595-7

How to cite this URL:
Juyal D, Rawre J, Dhawan B. Under diagnosis of the lymphogranuloma venereum serovars in the Indian population. Indian J Med Microbiol [serial online] 2019 [cited 2020 May 27];37:595-7. Available from: http://www.ijmm.org/text.asp?2019/37/4/595/284517




Dear Editor,

Sexually transmitted infections (STI) due to Chlamydia trachomatis continue to be a major public health problem worldwide. There is growing evidence that unprotected anal intercourse among men who have sex with men (MSM) is on the rise, increasing the prevalence of C. trachomatis worldwide, and similar trends are now being reported from India as well.[1],[2] In addition to the urogenital infections due to C. trachomatis (serovars D-K), more recently, lymphogranuloma venereum (LGV) infections (L-serovars) have gained importance, particularly among MSM and in women who indulge in receptive anal sex.[3] Although predominantly from Western countries (Europe, America and Canada), recent reports suggest an upsurge in LGV infections among MSM.[4],[5],[6]

LGV infection can manifest as severe proctitis, proctocolitis, rectal bleeding, ulceration, tenesmus and other symptoms found in patients with inflammatory bowel disease, which often may lead to misdiagnosis.[7] In prolonged infections, fissures and perirectal abscesses may also arise, and if left untreated, LGV infection can lead to irreversible anal strictures and lymphorrhoids. Rectal LGV is typically more severe than rectal chlamydia infection, which is usually asymptomatic[7] although rectal LGV is also asymptomatic in approximately 27%–43% of cases and may serve as hidden reservoirs for ongoing transmission of infection.[1] It is recommended to screen all MSM who report receptive anal sex during the past 6 months, for anorectal chlamydia infection and further type, the positive rectal samples for LGV genovars.[8] To ensure the appropriate management, particularly treatment, which is of longer duration compared to non-LGV rectal chlamydia, a correct diagnosis of LGV infection is imperative. However, it often goes undiagnosed or the diagnosis is limited only up to the level of rectal chlamydia, reason being lack of specialised laboratories, limited resources and lack of national surveillance system for LGV.

In the previous studies from our centre, conducted between 2011 and 2019,[1],[2],[9],[10],[11],[12],[13],[14],[15] the prevalence rate of C. trachomatis ranged from 4.5% to 18.3%. Patients attending HIV laboratory, obstetrics and gynaecology clinic (infertility clinic), STI clinic and gastroenterology clinic at our centre comprised the study population of our studies. [Table 1] depicts the details of studies conducted at our centre among various population groups. Over all these years, we have noticed a general rise in the chlamydia infection rate. In 2017, we reported the first case of proctitis due to C. trachomatis from India in a bisexual male patient.[16] Although we were unable to further type the isolate but considering the invasive anorectal disease and patient's sexual history, a clinical diagnosis of LGV proctitis was made. It is pertinent to mention here that before the aforesaid case, rectal swabs/rectal biopsies were never tested for C. trachomatis at our centre. However, after this case came into light, we started including rectal swabs/rectal biopsies to be tested for C. trachomatis in all male patients who gave a history of being MSM or females with a history of receptive anal intercourse. Later in 2017, we published the first study from India, reporting extragenital C. trachomatis infections wherein 30% of the male patients and 100% of female patients tested positive for rectal chlamydia.[1] Recently, we have submitted a report (unpublished data) where 53.3% of rectal samples have been tested positive for C. trachomatis. Due to the financial constraints typing of the isolates could not be performed, but the data extrapolated clearly pointed towards the changing trend of the sexual orientation in the Indian population with continuous upsurge in the extragenital chlamydia infections, which is quite worrisome.
Table 1: Summary of studies conducted at our centre among various patient population groups (2011-2019)

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The clinical presentation, patient management and treatment modalities are different for infections due to LGV genovars. Further typing of the isolates beyond rectal chlamydia may help in elucidating the wide clinical spectrum of chlamydial disease and will be useful in epidemiological studies, investigation of the transmission dynamics, surveillance of emerging genotypes or genovariants in population and understanding the genetic causes behind varied pathological mechanism of the disease. The information thus gained can be utilised in the formulation of screening programs, targeted prevention and optimizing therapeutic measures, aiming to reduce the disease transmission.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 ~ References Top

1.
Arif N, Juyal D, Sebastian S, Khanna N, Dhawan B. Analysis of laboratory testing results for Chlamydia trachomatis infection in an STI clinic in India: Need for extragenital screening. Int J Infect Dis 2017;57:1-2.  Back to cited text no. 1
    
2.
Agrawal SK, Rawre J, Khanna N, Dhawan B. Increase in Chlamydia trachomatis genital and extra-genital infections in Indian males. Indian J Med Microbiol 2019;37:285-6.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Gorbach PM, Manhart LE, Hess KL, Stoner BP, Martin DH, Holmes KK. Anal intercourse among young heterosexuals in three sexually transmitted disease clinics in the United States. Sex Transm Dis 2009;36:193-8.  Back to cited text no. 3
    
4.
O'Byrne P, MacPherson P, DeLaplante S, Metz G, Bourgault A. Approach to lymphogranuloma venereum. Can Fam Physician 2016;62:554-8.  Back to cited text no. 4
    
5.
Rob F, Jůzlová K, Krutáková H, Zákoucká H, Vaňousová D, Kružicová Z, et al. Steady increase of lymphogranuloma venereum cases, Czech Republic, 2010 to 2015. Euro Surveill 2016;21:30165.  Back to cited text no. 5
    
6.
Petrovay F, Balla E, Erdoösi T. Emergence of the lymphogranuloma venereum L2c genovariant, Hungary, 2012 to 2016. Euro Surveill 2017;22:1-5.  Back to cited text no. 6
    
7.
Stoner BP, Cohen SE. Lymphogranuloma venereum 2015: Clinical presentation, diagnosis, and treatment. Clin Infect Dis 2015;61 Suppl 8:S865-73.  Back to cited text no. 7
    
8.
Rawre J, Juyal D, Dhawan B. Molecular typing of Chlamydia trachomatis: An overview. Indian J Med Microbiol 2017;35:17-26.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Ghosh A, Dhawan B, Chaudhry R, Vajpayee M, Sreenivas V. Genital mycoplasma Chlamydia trachomatis infections in treatment naïve HIV-1 infected adults. Indian J Med Res 2011;134:960-6.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Dhawan B, Rawre J, Ghosh A, Malhotra N, Ahmed MM, Sreenivas V, et al. Diagnostic efficacy of a real time-PCR assay for Chlamydia trachomatis infection in infertile women in north India. Indian J Med Res 2014;140:252-61.  Back to cited text no. 10
[PUBMED]  [Full text]  
11.
Saigal K, Dhawan B, Rawre J, Khanna N, Chaudhry R. Genital mycoplasma and Chlamydia trachomatis infections in patients with genital tract infections attending a tertiary care hospital of North India. Indian J Pathol Microbiol 2016;59:194-6.  Back to cited text no. 11
[PUBMED]  [Full text]  
12.
Rawre J, Dhawan B, Malhotra N, Sreenivas V, Broor S, Chaudhry R. Prevalence and distribution of Chlamydia trachomatis genovars in Indian infertile patients: A pilot study. APMIS 2016;124:1109-15.  Back to cited text no. 12
    
13.
Arif N, Sebastian S, Khanna N, Sood S, Dhawan B. Comparative analysis of syndromic case management and polymerase chain reaction based diagnostic assays for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis and genital mycoplasmas in patients of genitourinary discharge. Indian J Med Microbiol 2017;35:286-9.  Back to cited text no. 13
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14.
Arif N, Rawre J, Patra S, Sreenivas V, Khanna N, Dhawan B. Increase in prevalence of Ureaplasma spp. in patients with genital tract infections in a tertiary care hospital of North India. Indian J Dermatol Venereol Leprol 2018;84:457-8.  Back to cited text no. 14
[PUBMED]  [Full text]  
15.
Rawre J, Dhawan B, Khanna N, Sreenivas V, Broor S, Chaudhry R. Distribution of Chlamydia trachomatis a genotypes in patients attending a sexually transmitted disease outpatient clinic in New Delhi, India. Indian J Med Res 2019;149:662-70.  Back to cited text no. 15
[PUBMED]  [Full text]  
16.
Dhawan B, Makharia GK, Juyal D, Sebastian S, Bhatia R, Khanna N. Chlamydia trachomatis proctitis masquerading as carcinoma rectum:First case report from India. Indian J Pathol Microbiol 2017;60:259-61.  Back to cited text no. 16
[PUBMED]  [Full text]  



 
 
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