Lymphogranuloma venereum accounted for almost 7% of rectal Chlamydia trachomatis in patients male-assigned at birth attending sexual health clinics in Baltimore between 2009 and 2016, and was not associated with prevalent or incident HIV as in other studies.
LGV prevalence among patients male-assigned at birth with rectal CT was 6.8% in Baltimore sexual health clinics from 2009-2016.
LGV was significantly associated with age greater than 25 years, transgender identity, and a history of syphilis in multivariable regression analysis.
Baseline LGV was not significantly associated with incident HIV or incident gonorrhea over 24 months of follow-up.
Baseline LGV was marginally associated with a new syphilis diagnosis over 24 months of follow-up.
LGV was not associated with prevalent or incident HIV in this study population, unlike findings reported in other studies.
The authors identified a lack of FDA-cleared diagnostic tests and insufficient surveillance infrastructure as barriers to understanding LGV epidemiology in the United States.
This research examined how common a severe form of chlamydia called lymphogranuloma venereum (LGV) was among people assigned male at birth who tested positive for rectal chlamydia at sexual health clinics in Baltimore between 2009 and 2016. LGV is caused by specific subtypes (L-serovars) of the chlamydia bacteria and can cause more serious symptoms than typical chlamydia, including rectal disease. The researchers found that nearly 1 in 14 rectal chlamydia cases in this group was actually LGV, and that LGV was more common in people over age 25, transgender individuals, and those with a prior syphilis diagnosis. The study also followed patients for two years to see whether having LGV at the start of the study predicted getting other sexually transmitted infections (STIs) later. LGV was not linked to new HIV or gonorrhea diagnoses, which was different from what other studies have found. However, there was a borderline statistical trend suggesting that people with LGV at baseline were about twice as likely to be diagnosed with syphilis within two years, though this result was not statistically definitive. This research suggests that LGV may be more prevalent in U.S. sexual health clinic populations than previously recognized, and that it disproportionately affects certain groups including transgender individuals. The authors highlight that there are currently no FDA-approved tests specifically for LGV in the United States, making it difficult to track how common it is or how its patterns are changing over time. Better diagnostic tools and surveillance systems would help public health officials understand and respond to LGV more effectively.
Hamill M, Deng Z, Hardick J, Tobias S, Page K, Quinn T, et al.. (2025). L-Serovar Rectal Chlamydia trachomatis in Patients Who Were Male-Assigned at Birth Attending Two Sexual Health Clinics, Baltimore, Maryland 2009-2016.. Sexually transmitted diseases. https://doi.org/10.1097/OLQ.0000000000002097