British Columbia researchers find cases of LGV are on the rise
LGV (lymphogranuloma venereum) is a sexually transmitted infection (STI) caused by a subtype of chlamydia. Before 2003, reports of LGV were rare in high-income countries. However, that year an outbreak was first reported in the Netherlands among gay, bisexual and other men who have sex with men (gbMSM). The outbreak then spread through sexual networks to other European countries and, shortly after, to Canada and the United States.
Those cases of LGV were associated with the following symptoms:
- anal/rectal ulcers
- painful bowel movements
- painfully swollen lymph nodes in the groin
Some men who developed anal/rectal ulcers related to LGV also developed symptoms such as fatigue, fever/chills and weight loss.
If left untreated, people with LGV-related anal ulcers can develop scar tissue that narrows the anus. Lymphatic vessels can also become scarred, leading to other problems.
LGV can be successfully treated with antibiotics.
In British Columbia
A team of researchers at the British Columbia Centre for Disease Control (BCCDC) reviewed its database on cases of LGV that were diagnosed in that province between November 2004 and October 2022. The researchers found a total of 545 cases distributed across the following periods:
- 2004 to 2017 – 205 cases (38%)
- 2018 to 2022 – 340 cases (62%)
The vast majority of cases (97%) were among gbMSM.
As the latter period of the study (2018 to 2022) is more relevant to the situation today, this article will focus on that.
The era of HIV pre-exposure prophylaxis
In British Columbia, pre-exposure prophylaxis (PrEP) became widely available in 2018. Most cases of LGV (62%) occurred in the period from 2018 to 2022 and were among HIV-negative men who used PrEP. The researchers stated that cases of LGV in the PrEP era were “often” symptom free compared to the time before PrEP was widely available. Specifically, the distribution of symptom-free cases of LGV was as follows:
- PrEP users – 47%
- HIV-positive people – 33%
- HIV-negative not using PrEP – 29%
Among people with HIV, those with a history of syphilis were at heightened risk for LGV.
Trends
The B.C. researchers found that cases of symptom-free LGV “increased considerably,” particularly among PrEP users (in the second period of the study). Among people with HIV, the proportion diagnosed with LGV decreased over the course of the study.
Overall, rates of LGV are increasing in B.C. This rise occurred around the same period that PrEP became available.
Why did some changes with LGV occur?
Beginning in 2003, LGV infections in high-income countries like Canada were concentrated among HIV-positive people (mostly gbMSM). The B.C. researchers suggest that the availability of PrEP may be increasing the mixing of sexual partnerships between people who are HIV negative and people who are HIV positive. The researchers also suggest that this mixing may in part be responsible for a shift in the populations affected by LGV.
The researchers noted that people who use PrEP undergo frequent screening (usually every three months) for STIs. It is therefore possible that increased screening for STIs in the PrEP era is detecting LGV relatively early in the course of infection, before symptoms have occurred. However, the researchers are not certain about this. Their findings underscore the need for further studies so that LGV in the current era can be better understood, not just in B.C. but in the rest of Canada.
In Western Europe
Studies in Belgium and France have also found an increased rate of LGV among gbMSM who use PrEP. In many cases reported, LGV was also symptom free.
Four of the largest HIV and STI clinics in Austria recently pooled their data on LGV for analysis. Data were collected from April 2014 to November 2020 in the cities of Vienna, Innsbruck, Linz and Graz. Researchers found that nearly half of the cases of LGV were symptom free. Most cases of LGV occurred in men with HIV (64%) compared to men without HIV (46%).
One reason for the lower rates of LGV in HIV-negative men in the Austrian study is that researchers there noted that the cost of PrEP is not fully subsidized and not as widely used as it is in other places.
Bear in mind
Recent reports from Austria, Belgium and British Columbia indicate that LGV is increasingly found in gbMSM. In many cases, LGV infection is symptom free. However, this may be due to the infection being found early. In all three places, more cases of LGV are being diagnosed in gbMSM who use PrEP.
Taken together, the data from B.C. and elsewhere underscore the need for frequent screening for STIs (including LGV) among gbMSM, including PrEP users. The data also draw attention to the need for more research on LGV in high-income countries.
—Sean R. Hosein
Resources
Lymphogranuloma Venereum – Government of Canada
Chlamydia and LGV guide: Key information and resources – Government of Canada
REFERENCES:
- Gupta AK, Lyons B, Hunter I, et al. The resurgence of lymphogranuloma venereum (LGV): changing presentation of LGV in the era of HIV pre-exposure prophylaxis (PrEP), 2004-2022. Sexually Transmitted Diseases. 2024; in press.
- Chromy D, Sadoghi B, Gasslitter I, et al. Asymptomatic lymphogranuloma venereum is commonly found among men who have sex with men in Austria. Journal der Deutschen Dermatologischen Gesellschaft. 2024; in press.