Lymphogranuloma venereum (LGV) is an ulcerative and invasive sexually transmitted infection (STI) caused by Chlamydia trachomatis (CT) serovars L1, L2, and L3. In the last 15 years it has become hyperendemic among men who have sex with men (MSM) in Western Europe. Current guidelines suggest treatment with Doxycycline 100 mg twice daily for 21 days (DoxLGV). Azithromycin 1 g orally once weekly for 3 weeks (extended azithromycin regimen (EAzLGV)) may be an alternative treatment, and here we investigatedits effectiveness as a treatment for LGV proctitis.
A prospective study was conducted between 2010 and 2017 at the STD Unit of a tertiary referral hospital in Barcelona (Spain). Males over 18 years of age with clinical proctitis,a recent history of unprotected receptive anal intercourse and microbiological confirmation of the diagnosis of LGVwere eligible for inclusion. All patients received a single dose of 1 gr of intramuscular ceftriaxone and were randomly assigned to receive: (i) DoxLGV; or, (ii) EAzLGV. Following treatment, individuals were assessed weekly for clinical symptoms and microbiologically by real-time multiplex polymerase chain reaction (M-PCR) for CT-LGV. Clinical cure (CC) was defined as disappearance of symptoms for at least 12 weeks; and microbiological cure (MC) as a negative rectal PCR for CT-LGV at week 4-6.
Of 152 individuals with LGV, 136 (89%) met inclusion criteria. All were MSM with a median age of 38 years (interquartile range 33;44), 46% foreigners and 95% HIV+. Median numbers of sexual partners were 3 [1-10] and 10 [4-37], 5] in the previous 3 and12 months, respectively. Average time between onset of the symptoms and diagnosis was 39 days (range: 1-180). Eleven patients with inclusion criteria were excluded because violation of assigned therapy. From the 136 individuals with proctitis, there were 125 patients left for final analysis, 82 received EAzLGV and 43 received DoxLGV. There were no treatment related adverse events or losses to follow up. CC was achieved in 81 of 82 (99%) vs 41 of 43 (95%) (p= 0,27) and MC in 97% vs 100% (p=1,00) in the EAzLGV and DoxLGV groups, respectively
Our findings show that an extended azithromycin regimen was as effective as standard doxicycline regimen and may be considered as an alternative treatment for LGV proctitis in an HIV-infected population of MSM