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Anal Lymphogranuloma Venereum Infection Screening With IgA Anti-Chlamydia trachomatis-Specific Major Outer Membrane Protein Serology

2010; Lippincott Williams & Wilkins; Volume: 37; Issue: 12 Linguagem: Inglês

10.1097/olq.0b013e3181e50671

1537-4521

Henry J.C. de Vries, Vitaly Smelov, Sander Ouburg, Jolein Pleijster, Ronald B. Geskus, Arjen Speksnijder, J S A Fennema, Servaas A. Morré,

Genital Health and Disease

In Brief Background: Anal lymphogranuloma venereum (LGV) infections, caused by Chlamydia trachomatis biovar L (Ct+/LGV+), are endemic among men who have sex with men (MSM). Anal non-LGV biovar Ct infections (Ct+/LGV−) can be eradicated with 1 week doxycycline, whereas Ct+/LGV+ infections require 3-week doxycycline. To differentiate Ct+/LGV+ from Ct+/LGV− infections, biovar-specific Nucleic Acid Amplification Test (NAAT) are standard, but also expensive and laborious. A chlamydia-specific serological assay could serve as an alternative test. Methods: MSM were screened for anal Ct+/LGV+ and Ct+/LGV− infections with a commercial nonspecific NAAT and an in house biovar L-specific NAAT. Serum samples were evaluated with chlamydia-specific anti-Major Outer Membrane Protein (MOMP) and antilipopolysaccharide assays of IgA and IgG classes. Asymptomatic patients were identified as: (1) no anal complaints or (2) no microscopic inflammation (i.e., <10 leucocytes per high power field in anal smears). The best differentiating assay was subsequently evaluated in 100 Ct+/LGV+ and 100 Ct+/LGV− MSM using different cut-off points. Results: The anti-MOMP IgA assay was the most accurate to differentiate Ct+/LGV+ (n = 42) from Ct+/LGV− (n = 19) with 85.7% sensitivity (95% confidence interval [CI], 72.2–93.3) and 84.2% specificity (95% CI, 62.4–94.5), even among asymptomatic patients. In a population comprising 98 Ct+/LGV+ and 105 Ct+/LGV− patients, the anti-MOMP IgA assay scored most accurate when the cut-off point was set to 2.0 with 75.5% (95% CI, 65.8–83.6) sensitivity and 74.3% (95% CI, 64.8–82.3) specificity. Conclusions: The IgA anti-MOMP assay can identify a considerable proportion of the (asymptomatic) anal LGV infections correctly. Yet, biovar L-specific NAAT are still the preferred diagnostic tests in clinical settings. Four Chlamydia-specific serologic assays were evaluated to diagnose anal lymphogranuloma venereum infections. An IgA anti-Major Outer Membrane Protein assay showed the best characteristics (sensitivity 75.5% ± 65.8–83.6, specificity 74.3% ± 64.8–82.3, CI 95%).