Up the radar for LGV: New cases reported
Put your diagnostic skills into high gear to spot lymphogranuloma venereum (LGV), a sexually transmitted disease (STD) caused by a type of Chlamydia trachomatis. The Centers for Disease Control and Prevention (CDC) has identified a number of cases from specimens submitted from health departments in New York City, San Francisco, and Atlanta.
Up to now, LGV infections rarely occurred in the United States and other industrialized nations; however, U.S. public health officials called for providers to monitor for the STD following a late 2004 outbreak of the infection, primarily in men who have sex with men, in the Netherlands and other European countries.1,2,3
Since LGV is not a nationally notifiable disease, public health officials do not have information about how much LGV has been present previously compared to what is being seen now, says Catherine McLean, MD, medical epidemiologist with the CDC Division of STD Prevention.
"At this point, in response to increases that have been reported in Europe, we at CDC have been applying more specific laboratory typing techniques to determine whether in fact LGV is present here, and we have confirmed that it is," she states.
Two cases of the STD have been confirmed in New York City, prompting local public health officials to send an alert to physicians warning them to be on the lookout for the disease.4 Three other cases have been spotted: two in San Francisco, and one in Atlanta.4
"We are deferring to the state and local health jurisdictions to report on individual cases in their areas," states McLean.
Spot the symptoms
To help clinicians detect and treat LGV, the CDC has posted an information sheet on its Division of STD Prevention web site, www.cdc.gov/std. (See resources to learn how to access this information.)
How can you spot LGV? Symptoms include:
- mucous or purulent anal discharge;
- rectal bleeding;
- constipation;
- inguinal/femoral lymphadenopathy (buboes);
- genital or rectal ulcer or papule;
- anal spasms;
- tenesmus.
Clinicians may find it difficult to diagnose LGV since its symptoms are not recognized as typical symptoms of an STD and are similar to those that are caused by other conditions and infections. The CDC is asking clinicians to complete a questionnaire for any patient suspected of having LGV. Completion of the questionnaire will aid public health officials in understanding characteristics of persons with LGV in the United States and will contribute to controlling the disease.
The CDC’s chlamydia laboratory is providing laboratory support for states that lack laboratory capacity to perform LGV diagnostic testing. Specimens are tested for C. trachomatis, if such testing is not available locally, then typed for LGV if tests are positive for the STD. Clinicians and laboratories may submit specimens to the CDC lab using procedures outlined in a CDC specimen collection form. (See resources to learn how to access the form.)
Once LGV is diagnosed, it is treatable with antibiotics. If left untreated, the disease can lead to chronic scarring, constipation, rectal pain, and abscesses. Like other ulcerative STDs, LGV also can increase the risk for HIV transmission.
"LGV is a serious condition, and its emergence in New York City reflects continuing high levels of unsafe sexual activity among men who have sex with men," states Thomas Frieden, MD, MPH, New York City’s health commissioner. "Medical providers who care for gay and bisexual men should be alert for symptoms of LGV."
References
1. Lymphogranuloma venereum among men who have sex with men — Netherlands, 2003-2004. MMWR 2004; 53:985-988.
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. Clin Infect Dis 2004; 39:996-1,003.
3. Gotz HM, Ossewaarde JM, Nieuwenhuis RF, et al. A cluster of lymphogranuloma venereum among homosexual men in Rotterdam with implications for other countries in Western Europe. Ned Tijdschr Geneeskd 2004; 148:441-442.
4. Santora M. 2 cases of rare sex disease are diagnosed in New York. The New York Times, Feb. 3, 2005: Accessed at www.nytimes.com/2005/02/03/nyregion/03disease.html.
The Centers for Disease Control and Prevention’s Division of STD Prevention provides information on LGV surveillance activities, and LGV diagnosis and treatment on its web site, www.cdc.gov/std. Click on "LGV Surveillance" to access information that includes versions of a provider information sheet, patient questionnaire, and specimen collection form for clinicians who have a patient suspected of having LGV.
Put your diagnostic skills into high gear to spot lymphogranuloma venereum (LGV), a sexually transmitted disease caused by a type of Chlamydia trachomatis.
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