The resurgence of lymphogranuloma venereum (LGV): changing presentation of LGV in the era of HIV pre-exposure prophylaxis (PrEP), 2004-2022

Abstract

Abstract Background Before the early 2000s, the sexually transmitted infection lymphogranuloma venereum (LGV) was rare in high-income countries. Initially, most cases in these countries were among symptomatic men who have sex with men (MSM) living with HIV. In the context of widespread HIV pre-exposure prophylaxis (PrEP), LGV’s epidemiology may be changing. We aim to characterize the epidemiology and clinical presentation of LGV in the PrEP era. Methods A retrospective chart review was performed on all LGV cases occurring between 11/2004-10/2022 in British Columbia (BC), Canada. Cases were stratified by having occurred before (2004-2017) or after widespread PrEP availability in BC (2018-2022). Annual rates and test positivity percentages were calculated. Bivariate logistic regression was performed to identify drivers of asymptomatic infection in the PrEP era. Results Among 545 cases identified, 205 (37.6%) occurred pre-PrEP and 340 (62.4%) occurred during the PrEP era. Most cases were among MSM (97.2%). The estimated rate of LGV has doubled from 2018 to 2022, reaching 1,535.2 cases per 100,000 PrEP users. Most PrEP-era cases were among HIV-negative individuals (65.3%), particularly those on PrEP (72.6%). Cases in the PrEP era were often asymptomatic compared to pre-PrEP (38.6% vs. 19.3%; p < 0.001). PrEP users were more likely to experience asymptomatic infection compared to HIV-negative PrEP non-users (odds ratio 2.07, 95% confidence interval 1.07, 3.99). Conclusion In context of increased asymptomatic testing, LGV may be increasing in BC. Most infections now occur among HIV-negative MSM. A high proportion of infections are asymptomatic.