By Liz Highleyman

Chlamydia Trachomatis Bacteria

Over the past 2 years, lymphogranuloma venereum (LGV) - a previously rare sexually transmitted disease caused by certain types (L serovars) of Chlamydia trachomatis bacteria - has emerged as a significant concern among men who have sex with men in several European countries and U.S. cities.

While the more typical forms of chlamydia often cause no symptoms or mild genital discharge, LGV may lead to genital and rectal ulcers, proctitis (rectal inflammation), flu-like symptoms, severe gastrointestinal distress, and swollen lymph nodes.

In the January 1, 2007 issue of Clinical Infectious Diseases, British researchers described the largest case series of LGV to date, including detailed epidemiological and clinical characteristics of the epidemic in the United Kingdom.

A national diagnostic service and surveillance system was established in October 2004, after several LGV cases had been reported. Cases were confirmed by genotypic tests demonstrating the presence of Chlamydia trachomatis bacteria with a serovar linked to LGV (L1, L2, or L3). For confirmed cases, an enhanced surveillance questionnaire was sent to the patient's clinician.

Results

• Through February 2006, a total of 327 cases of LGV were confirmed.

• Cases were diagnosed across the United Kingdom, with the majority in London (71%) and Brighton (13%).

• Case reports were received for 282 MSM.

• The majority (96%) had proctitis, and many had severe local and systemic symptoms.

• 76% of patients with LGV were HIV positive, 19% had hepatitis C virus (HCV), and 39% had other sexually transmitted infections.

• 9 cases of HIV infection were diagnosed around the same time as LGV.

• Most cases were acquired within the United Kingdom, although patients with early cases were more likely to report contacts in the Netherlands (where an outbreak among MSM was reported in 2004).

Conclusion

"We found a significant burden of this once-rare sexually transmitted infection among MSM in the United Kingdom," the authors wrote in conclusion. "LGV may be contributing to the epidemic of [HIV] infection by facilitating transmission. Further control efforts are required, including awareness campaigns, continued detailed surveillance, and expanded chlamydia testing among MSM."

1/19/07

Reference
H Ward, I Martin, N Macdonald, and others. Lymphogranuloma venereum in the United Kingdom. Clinical Infectious Diseases 44(1): 26-32. January 1, 2007.