Identification of Chlamydia trachomatis LGV L2 infection: a case report of chronic epididymitis

PAIRA, DANIELA A.; OLIVERA, CAROLINA; TISSERA, ANDREA D.; OLMEDO, JOSE J.; MOLINA, ROSA I.; SAKA, HECTOR A.; MOTRICH, RUBEN D.

Mar del Plata

Congreso; Reunión Conjunta SAIC, SAI&FAIC, SAFIS 2022; 2022

Chlamydia trachomatis (CT) is an obligate Gram-negative intracellular bacterium being the most prevalent sexually transmitted bacterial infection worldwide. Although specific antimicrobial therapy is highly effective, a high rate of CT male urogenital infections are asymptomatic, leading patients not to seek treatment and allowing continuous transmission of the infection. Lymphogranuloma venereum (LGV) is caused by CT genotypes L1-L3. No confirmed cases of CT-LGV had been reported in Argentina until 2017, when 33 cases of CT-LGV infection were detected in a group of men who had sex with men, 90% HIV positive, and presenting with broad clinical manifestations. In the present work, we report the case of a 36 y.o. heterosexual men, HIV negative, who presented in August 2018 referring symptoms of chronic epididymitis (more than 6 months of evolution), with right testicular cord swelling and extremely painful upon palpation. Semen analysis revealed oligoasthenoteratozoospermia without leukocytospermia. The screening of several common uropathogens by culture and PCR showed the sole infection with CT. Interestingly, ompA gene sequencing revealed a CT-LGV L2 genotype. Moreover, molecular epidemiological analysis by multi-locus sequence typing (MLST) Uppsala strategy confirmed CT-LGV L2 genotype as ST 144. Strikingly, the patient did not present external lymphadenopathies, which are commonly observed in CT-LGV2 infections. After treatment with doxycycline 100 mg/12h for 7 days, the signs and symptoms gradually remitted until resolution. A new semen analysis performed 2 months later revealed complete resolution of the infection and a significant improvement in sperm quality.From the epidemiological point of view, this would be the first report of CT LGV-L2 detection in Argentina, in a male, heterosexual, HIV-negative patient, with clinical symptoms of chronic epididymitis, constituting valuable epidemiological information with a significant impact on public health.