TreatmentUpdate
149

2005 April/May 

When germs travel

Before antibiotics became widely available, outbreaks of the bacterial infection LGV, caused by several strains of Chlamydia, appeared regularly in the United States and Western Europe. Once antibiotics became available, the few cases that did occur were thought to be imported from regions where LGV infection continues to cause problems, such as:

  • East and West Africa
  • India
  • Southeast Asia
  • Central and South America
  • parts of the Caribbean, such as the Bahamas

However, beginning in February 2003, three HIV positive men sought medical help at an STD clinic in Rotterdam, the Netherlands, because of symptoms of a possible infection. These three men helped researchers contact other men (with whom they had previously had sex). In an average year, the Netherlands usually has only a handful of cases of LGV, so as the size of the outbreak became clear, these cases triggered an investigation. The Rotterdam team focused on the 14 initial cases and here’s what they found:

  • 11 of the 14 men were HIV positive.
  • Four of the men were taking highly active antiretroviral therapy (HAART).
  • In half of the 14 cases there was another sexually transmitted disease (STD) present, including rectal gonorrhea, genital herpes, syphilis, hepatitis B, genital warts.
  • All of the men were white and lived in the Netherlands, particularly in Amsterdam or Rotterdam.
  • The average age of the men was 39 years.
  • Most of the men had had more than 10 sexual partners in the previous six months.
  • All 14 men had engaged in anal sex.
  • 10 of the men reported that they had engaged in regular fisting.
  • Condom use was very limited, with about half of the men reporting that they never used them and the other half reporting that they used them some of the time.

Symptoms

Among 12 of the men, the most common problems for which they sought help were as follows:

  • a creamy discharge consisting of mucus and pus from the anus
  • constipation
  • rectal bleeding

Less common symptoms included the following:

  • a constant need to empty the bowel, accompanied by pain, cramping and straining
  • involuntary weight loss

None of the men reported having swollen lymph nodes in the groin. This is important because historically LGV infection is associated with swollen lymph nodes in that part of the body.

Scoping around

Doctors found ulcers inside the rectums of all the men. PCR tests revealed that Chlamydia was present in almost all biopsies of the rectum. Further analyses revealed that in most cases the men had strains of Chlamydia that were called L1, L2 and L3—the cause of LGV.

Treatment

All the men with confirmed or suspected LGV were treated with antibiotics:

  • doxycycline, 100 mg twice daily for 21 days

Fortunately, they all recovered from LGV infection. If left untreated, LGV can cause scarring of the colon and possibly bursting of lymph nodes in the groin.

The research team suspects that these men are merely a small part of a much larger outbreak that is appearing across Western Europe. This is because many of the men had a number of sexual contacts, most of whom were anonymous partners who cannot be contacted and warned that they, too, might have LGV. The 14 men in the study were part of an international sex network, meeting, as the researchers put it, on the “leather scene,” and therefore, not surprisingly, further outbreaks of LGV have appeared in the following places:

  • Belgium
  • France
  • Germany
  • Spain
  • Sweden
  • United Kingdom

In addition, reports from New York City and San Francisco indicate that cases of LGV are being investigated there. Several cases of LGV are also being investigated by public health authorities in Ontario and Western Canada.

Because LGV is associated with ulcers and bleeding, it has the potential to facilitate the spread of HIV as well as other sexually transmitted infections.

REFERENCES:

1. Blank S, Schillinger JA, Harbatkin D. Lymphogranuloma venereum in the industrialised world. Lancet 2005;365(9471):1607-1608.

2. Nieuwenhuis RF, Ossewaarde JM, Gotz HM, et al. Resurgence of lymphogranuloma venereum in Western Europe: an outbreak of Chlamydia trachomatis serovar l2 proctitis in The Netherlands among men who have sex with men. Clinical Infectious Diseases 2004; 39(7):996-1003.

3. Gotz HM, van Doornum G, Niesters HG, et al. A cluster of acute hepatitis C virus infection among men who have sex with men - results from contact tracing and public health implications. AIDS 2005;19(9):969-974.

4. French P, Ison CA and Macdonald N. Lymphogranuloma venereum in the United Kingdom. Sexually Transmitted Infections 2005;81(2):97-98.

5. Herida M, Sednaoui P, Couturier E, et al. Rectal lymphogranuloma venereum, France. Emerging Infectious Diseases 2005;11(3):505-506.

6. Meyer T, Arndt R, von Krosigk A et al. Repeated detection of lymphogranuloma venereum caused by Chlamydia trachomatis L2 in homosexual men in Hamburg. Sexually Transmitted Infections 2005 ;81(1):91-92.

7. Centers for Disease Control and Prevention (CDC). Lymphogranuloma venereum among men who have sex with men--Netherlands, 2003-2004. Morbidity and Mortality Weekly Report 2004;53(42):985-988.

8. Berglund T, Bratt G, Herrmann B, et al. Two cases of ). Lymphogranuloma venereum in homosexual men in Stockholm. Eurosurveillance Weekly 2005;10(9).

Created on: 2005 June 6

Author: Hosein SR