Chronic epididymitis due to Chlamydia trachomatis LGV-L2 in an HIV-negative heterosexual patient: a case report

PAIRA, DANIELA ANDREA; OLMEDO, JOSÉ JAVIER; OLIVERA, CAROLINA; TISSERA, ANDREA DANIELA; MOLINA, ROSA ISABEL; RIVERO, VIRGINIA ELENA; SAKA, HÉCTOR ALEX; MOTRICH, RUBÉN DARÍO

Frontiers in Public Health

Frontiers Media

Año: 2023 vol. 11

Chlamydia trachomatis is an obligate intracellular pathogen and the leadingbacterial cause of sexually transmitted infections worldwide. Chlamydiatrachomatis genovars L1–L3 are responsible for lymphogranuloma venereum(LGV), an invasive sexually transmitted disease endemic in tropical and subtropicalregions of Africa, South America, the Caribbean, India and South East Asia. Thetypical signs and symptoms of C. trachomatis LGV urogenital infections in meninclude herpetiform ulcers, inguinal buboes, and/or lymphadenopathies. Since2003, endemic cases of proctitis and proctocolitis caused by C. trachomatisLGV emerged in Europe, mainly in HIV-positive men who have sex with men(MSM). Scarce data have been reported about unusual clinical presentations of C.trachomatis LGV urogenital infections. Herein, we report a case of a 36-year-oldheterosexual, HIV-negative male declaring he did not have sex with men ortrans women, who presented to the Urology and Andrology outpatient clinic ofa healthcare center from Cordoba, Argentina, with intermittent testicular painover the preceding 6 months. Doppler ultrasound indicated right epididymitisand funiculitis. Out of 17 sexually transmitted infections (STIs) investigated, apositive result was obtained only for C. trachomatis. Also, semen analysis revealedoligoasthenozoospermia, reduced sperm viability as well as increased spermDNA fragmentation and necrosis, together with augmented reactive oxygenspecies (ROS) levels and the presence of anti-sperm IgG autoantibodies. In thiscontext, doxycycline 100 mg/12 h for 45 days was prescribed. A post-treatmentcontrol documented microbiological cure along with resolution of clinical signsand symptoms and improved semen quality. Strikingly, sequencing of the ompAgene revealed C. trachomatis LGV L2 as the causative uropathogen. Remarkably,the patient did not present the typical signs and symptoms of LGV. Instead,the infection associated with chronic testicular pain, semen inflammation andmarkedly reduced sperm quality. To our knowledge, this is the first reportedevidence of chronic epididymitis due to C. trachomatis LGV L2 infection in anHIV-negative heterosexual man. These findings constitute important and valuableinformation for researchers and practitioners and highlight that C. trachomatisLGV-L2 should be considered as putative etiologic agent of chronic epididymitis,even in the absence of the typical LGV signs and symptoms.