Lymphogranuloma venereum - Annual Epidemiological Report 2016 [2014 data]

Key facts

• In 2014, 1 416 cases of LGV were reported in 21 countries.
• Three countries (France, the Netherlands and the United Kingdom) accounted for 87% of notified cases.
• Almost all cases were reported among men who have sex with men; in those cases with known HIV status, 87% were HIV positive in 2014.
• The number of cases reported in 2014 increased by 32% compared with 2013.
• A number of countries have not reported LGV cases over the years, suggesting considerable under-diagnosis and underreporting.

Methods

Click here for a detailed description of the methods used to produce this annual report

In 2014, the majority of reporting countries (12) used the EU case definitions. Four countries reported using national case definitions, and five countries did not report which case definition they were using. Surveillance systems for LGV in Europe vary: 14 countries reported having comprehensive surveillance systems, but five countries operate sentinel systems which only capture LGV diagnoses from a selection of clinics (Annex).

Reporting of LGV infection is compulsory in all countries with comprehensive systems, with a few exceptions: the United Kingdom has a comprehensive system, but reporting is not compulsory; reporting is compulsory in Hungary, which has a sentinel system. Reporting is voluntary in the remainder of countries with sentinel systems.

Rates of LGV infection are not calculated because many LGV surveillance systems are not able to generate data that are considered representative of the national population. There are also significant differences in the availability of LGV diagnostics across Europe.

Epidemiology

In 2014, 21 countries provided data on the reporting of LGV cases. Eleven of these 21 countries reported a total of 1 416 cases, while the remaining 10 countries reporting zero cases (Table 1). Compared with 2013, the number of cases reported in 2014 increased by 32%. All countries except Finland, Italy and Malta reported an increase in case numbers. The largest proportional increase was reported in Ireland (sixfold) and the Czech Republic (1.5-fold).

Transmission category was reported for 889 cases in 2014 (63% of all reported cases). All but four were reported among MSM. Age was reported for all but one case, with the large majority of cases distributed evenly among 25–34-year-olds (29%), 35–44-year-olds (34%) and those aged 45 years or over (33%) (Figure 1).

In 2014, information on HIV status was available for 1 354 LGV cases (96%), of whom 54% were reported as HIV positive, 8% as HIV negative and 38% as unknown. Of cases with known HIV status, 87% were HIV positive. Between 2005 and 2014, information on HIV status was available for 4 647 cases (74% of all reported cases), of whom 65% were reported as HIV positive, 14% as HIV negative, and 21% as unknown.

Between 2005 and 2014, 6 303 cases of LGV were reported in 12 countries, with the majority of cases reported in the United Kingdom (53%; 3 367 cases), France (20%; 1 276 cases) and the Netherlands (16%; 1 023 cases). The overall increasing trend for reported cases of LGV between 2005 and 2014 is due to an increase in the number of reporting countries and an increase in case number in most of the reporting countries (Figure 2).

Discussion

In 2014, the number of reported cases of LGV continued to increase in western and central European countries. The largest increases were reported from Ireland and the Czech Republic, but many other countries also reported increases. The number of reported cases is an underestimate because many countries do not routinely report LGV and the diagnosis of LGV requires confirmation through genotyping. The increase in reported cases indicates that LGV transmission continues mainly among HIV-positive MSM undertaking high-risk practices [1-3]. Different, and at times insufficient, testing strategies fail to detect a substantial number of asymptomatic cases [4].

Public health conclusions

The increasing number of cases of LGV in Europe mirror the trend for other sexually transmitted diseases, with increases predominantly due to transmission between MSM. Effective interventions need to be identified and targeted at this group of predominantly HIV-positive MSM who might have less incentive to use condoms. In addition, clinical suspicion and early diagnosis is essential in order to prevent complications. In many parts of Europe, surveillance for LGV is not well developed due to limited availability of diagnostics. Little information is therefore available on the incidence of the infection in some parts of Europe. An ECDC project will be piloting enhanced LGV surveillance in these countries in order to try to shed more light on the scope of the problem.

References

1. Childs T, Simms I, Alexander S, Eastick K, Hughes G, Field N. Rapid increase in lymphogranuloma venereum in men who have sex with men, United Kingdom, 2003 to September 2015. Euro Surveill. 2015;20(48):30076. doi: 10.2807/1560-7917.
2. Macdonald N, Sullivan AK, French P, White JA, Dean G, Smith A, et al. Risk factors for rectal lymphogranuloma venereum in gay men: results of a multicentre case-control study in the UK. Sex Transm Infect. 2014 Jun;90(4):262-8.
3. Rönn M, Hughes G, Simms I, Ison C, Alexander S, White P, et al. Challenges presented by re-emerging sexually transmitted infections: an observational study of lymphogranuloma venereum in the U.K. J AIDS Clin Res. 2014 Aug 1;5(8):1000329 .
4. Koper NE, van der Sande MA, Gotz HM, Koedijk FD. Lymphogranuloma venereum among men who have sex with men in the Netherlands: regional differences in testing rates lead to underestimation of the incidence, 2006–2012. Euro Surveill. 2013 Aug 22;18(34).

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* The European Surveillance System (TESSy) is a system for the collection, analysis and dissemination of data on communicable diseases. EU Member States and EEA countries contribute to the system by uploading their infectious disease surveillance data at regular intervals.