Lymphogranuloma Venereum Surveillance in Chlamydia trachomatis Positive Male Rectal Swabs Collected from I Want The Kit in Maryland, United States.

Background: Infection with Chlamydia trachomatis (CT) can have distinct clinical presentations, such as trachoma, or lymphogranuloma venereum (LGV). Certain populations are at greater risk for LGV acquisition and transmission, which requires a longer duration of therapy than other urogenital CT sexually transmitted infections (STIs). Commercial assays are not available in the United States to distinguish LGV from non-LGV serovars.

Methods: LGV real-time PCR was performed on rectal CT-positive samples (N = 93) obtained from men (N = 80) who ordered from a mail-in self-collection STI service between April 2021 and February 2024. pmpH gene sequencing was performed on all samples to confirm LGV versus non-LGV, and multi-locus sequence typing (MLST) was performed on LGV-positive samples (N = 7) for additional confirmation.

Results: LGV was detected in 7.5% (7/93) of samples by real-time PCR, with pmpH sequencing and MLST confirming 100% (7/7) of these results. Overall, pmpH sequencing data was obtained for 92% (86/93) of samples with the following serovar distribution based on BLAST analysis: 54% (47/86) J, 28% (24/86) F, 9% (8/86) E and 8% (7/86) L. No individual had more than one LGV positive sample. No statistically significant associations with demographic factors were identified.

Conclusions: LGV was detected in CT-positive rectal swabs from users of an online, mail-in, self-collect STI testing platform in Maryland. These data suggest that increased LGV reflexive testing may be warranted. These data also illustrate that mail-in programs for routine STI testing may be leveraged for public health surveillance purposes.