LGV: The new chlamydia
I’ve heard about a new sexually transmitted infection that’s going around. What is it?
It’s called lymphogranuloma venereum, or LGV for short. It’s caused by an unusual form of chlamydia. Unlike other forms, this strain of chlamydia is invasive and can infect the lymphatic system. Although commonly found in parts of Africa, Asia, South America and the Caribbean, it has been rare in Europe since the introduction of antibiotics. Since December 2003, however, outbreaks of LGV have been reported in gay men across Europe, especially in the Netherlands, as well as in Paris, Stockholm and Hamburg. The infection is relatively rare in the UK with only a handful of cases reported so far.
How do I know if I’ve picked it up?
The commonest symptom is proctitis: pain and inflammation inside the anus
and rectum, sometimes accompanied by swollen glands in the groin, a discharge
of mucus from the rectum, constipation or bleeding. If left untreated, LGV
can lead to a generalised inflammation of the lymphatic system and genital
elephantiasis (extreme swelling of the genitals).
As it is relatively rare, doctors have sometimes confused the symptoms with
syphilis, Crohn’s disease or herpes. However, the Health Protection
Agency initiated enhanced surveillance measures for the infection in October
2004 across the UK. This has raised awareness of the disease among doctors,
nurses and public health professionals and should increase detection rates.
So who’s at risk? Is it just gay men?
LGV can infect both men and women regardless of HIV infection. However, the
latest outbreaks have been seen exclusively in gay men, most of whom are white
and HIV positive. Most of the affected men also had another sexually transmitted
infection [STI] including syphilis, gonorrhoea, herpes or hepatitis B or C.
Fisting looks like it could be a risk factor for getting LGV, as well as for
catching hepatitis C. Some recent cases, though, have been reported in men
who have claimed never to have engaged in fisting. Some experts think that
these cases may have been spread through unprotected anal sex.
Investigators looking into the transmission of LGV are concerned that the
cases seen across Europe could be linked to sex parties that took place in
the Netherlands. These parties attracted men from across Europe, possibly
leading to clusters of the disease being seen in western European cities.
I’m worried that I might have been exposed to LGV and I do have some pain in my back passage. What should I do?
You should get a sexual health check-up at your local GUM or HIV clinic as
soon as you can. This will include a screen for a range of sexually transmitted
infections including LGV. If you have LGV, it can be treated very easily with
a three-week course of doxycycline, taken by mouth.
Remember though, that LGV is still rare in the UK so the chances of picking
it up are fairly slim, especially if you have not had unprotected sex or done
any fisting recently.
Is there anything else I should be aware of?
A small outbreak of another STI called shigellosis has recently been seen
among gay men in London following similar outbreaks in San Francisco, Amsterdam,
Sydney and Berlin. Shigellosis is caused by a bacterium called Shigella sonnei,
which is highly infectious and can cause severe, prolonged diarrhoea. It is
often more serious in HIV positive people. The bacteria can be transmitted
through poor hygiene or the ingestion of a very small amount of faeces during
oral or anal sex. This may occur through rimming, fingering, fisting, handling
condoms or sex toys after use in the anus, or occasionally during oral sex.
Experts have advised gay men to remember to wash their hands after sex, after
using the toilet and before eating or preparing food. If you have symptoms,
you should avoid sex and see your regular doctor as soon as you can.
• NAM provides information to help you think about your use of HIV treatments,
but this is not intended to replace discussion with your doctor.
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