First confirmed Lymphogranuloma venereum (LGV) cases among MSM in Bulgaria, 2020–2021

Although the spread of Lymphogranuloma venereum (LGV) among European men who have sex with men (MSM) has been endemic since 2003, to the author’s knowledge no LGV cases have been confirmed in Bulgaria up to date and treatment in suspected LGV patients has been presumptive due to lack of diagnostic capacity. The objective of the study was to genotype C. trachomatis-positive samples from attendees of a sexual health center in Sofia from 2020-2021 in order to be able to detect LGV circulation among MSM in Bulgaria. During the study period, a total of 246 MSM were tested with commercially available nucleic acid amplification tests (NAATs) to detect C. trachomatis in first void urine (FVU), pharyngeal and rectal swabs. Thirty-one consecutive clinical samples found positive for C. trachomatis during diagnostic testing were retrospectively analyzed for the presence of C. trachomatis serovars L1-L3. LGV genovars-specific C. trachomatis DNA was detected by pmpH PCR from the same specimen. LGV genovars were confirmed with partial ompA gene sequencing. Altogether 31 C. trachomatis-positive samples (22 FVU, 1 pharyngeal and 8 rectal swabs) were successfully typed by pmpH PCR. Twenty-nine samples contained non-LGV and two samples LGV C. trachomatis types. All the LGV types were found in rectal samples. Detected L types were confirmed to be serovar L2 with ompA sequencing. The data show that LGV circulate also among Bulgarian MSM, which underscores the importance of expanding LGV testing capacity in order to better inform patient management. Enhanced surveillance and genotyping programs could help measure and monitor LGV prevalence in Bulgaria.