receptive anal sex is the key risk factor for rectal LGV (lymphogranuloma
venereum) infections in gay and other men who have sex with men (MSM), UK
researchers report. Their case-controlled study published in the online edition
of Sexually Transmitted Infections also
showed that 89% of people with LGV were HIV positive. Fisting and drug use were also
identified as risk factors for infection.
raise awareness of LGV and of the symptoms among gay men, particularly
HIV-positive men, should be updated and maintained,” write the authors. “Sexual
health clinics should identify men at risk, encourage frequent STI screening,
provide adequate treatment and contact tracing, and offer appropriate support
to minimise the risks associated with sexual behaviour and substance use.”
LGV is a bacterial
STI caused by strains of Chlamydia. It is associated with invasive, ulcerative
disease and can be cured with a 21-day course of antibiotic therapy.
There is an
ongoing epidemic of LGV among gay men in the UK. Although
the first cases were recorded as long ago as 2003, there is still
uncertainty about its risk factors.
A team of UK
investigators therefore designed a case-controlled study involving six
treatment centres in Brighton, Glasgow and London, all with high LGV caseloads. The study population was restricted to men reporting sex with other men.
The cases (n = 90)
were men with confirmed rectal LGV infection. There were two types of controls:
men with rectal symptoms possibly associated with LGV (n = 74) and asymptomatic
men without such symptoms (n = 69). Participants were recruited between August 2008
and December 2010.
provided details of their HIV infection status, recent sexual behaviour and use
of recreational drugs.
Participants had a
median age of 39 years. HIV prevalence was significantly higher among the cases
(89%), compared to both the symptomatic (48%) and asymptomatic (68%) controls.
In terms of sexual
behaviour, cases were significantly more likely than asymptomatic controls to
report being fisted (22 vs 1%; p < 0.001), fisting another man (37% vs.
4%; p < 0.001), unprotected receptive anal sex (93% vs. 43%; p < 0.001)
and unprotected insertive anal sex (85% vs. 46%; p < 0.001).
The cases were
also more likely than the asymptomatic controls to report more than ten recent
sexual partners (45 vs 24%; p = 0.006) and having anonymous partners (57 vs
30%; p = 0.001).
third of cases, but only 16% of the asymptomatic controls, said they had met
partners at a sex party (p = 0.024).
Cases were also
more likely than the asymptomatic controls to report the use of certain
recreational drugs, especially GHB/GBL (57 vs 21%; p < 0.001) and
methamphetamine (46 vs 10%; p < 0.001).
for confounding factors, the investigators identified receptive unprotected anal sex (AOR
= 10.7; 95% CI, 3.5-32.8; p < 0.001), fisting another man (p = 0.005),
anonymous sex (p = 0.20) and sex under the influence of GHB/GBL (p = 0.011) as
risk factors for confirmed rectal LGV infection in comparison with asymptomatic
The authors then
compared the characteristics of the confirmed cases with those of the
The cases were
more likely to report receptive unprotected anal sex (93 vs 68%; p <
0.001); insertive fisting (80 vs 56%; p = 0.002), more than ten recent sexual
partners (45 vs 28%; p = 0.026), rectal douching to prepare for sex (84 vs
54%; p < 0.001), use of GHB/GBL (57 vs 32%; p = 0.002), use of
methamphetamine (46 vs 20%; p = 0.001), group sex (49 vs 27%; p = 0.018),
unprotected anal intercourse with an HIV-positive partner (78 vs 45%; p <
0.001) and sero-concordant unprotected anal intercourse between HIV-positive
partners (74 vs 40%; p < 0.001).
factors were unprotected insertive anal sex and rectal douching.
unprotected receptive anal intercourse as a key risk factor for rectal LGV
infection in MSM,” write the authors. “This finding, although not unexpected,
supports the hypothesis that rectal infection is due to direct inoculation…this
can occur either directly from men with urethral infection, or indirectly by
transfer from another infected rectum on a covered or uncovered penis, sex toy or
finger without the insertive partner necessarily having LGV infection.”
They believe their
findings have implications for LGV prevention campaigns, supporting “advice
that condoms provide protection against LGV, and that particular care is
required in group sex situations”.