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Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case-control study in the U.K.

Abstract：

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.

journal_name

Sex Transm Infect

journal_title

Sexually transmitted infections

authors

Pallawela SN,Sullivan AK,Macdonald N,French P,White J,Dean G,Smith A,Winter AJ,Mandalia S,Alexander S,Ison C,Ward H

doi

10.1136/sextrans-2013-051401

subject

Has Abstract

pub_date

2014-06-01 00:00:00

pages

269-74

issue

eissn

1368-4973

issn

1472-3263

pii

sextrans-2013-051401

journal_volume

pub_type

杂志文章,多中心研究

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Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case-control study in the U.K.