2 NYC Residents Diagnosed
With LGV - Rare STD

From Patricia Doyle, PhD
From ProMED-mail
Source: New York City Dept of Health & Mental Hygiene Press Release
Health officials announced today, 2 Feb 2005, that 2 New Yorkers have been diagnosed with a rare form of Chlamydia known as lymphogranuloma venereum, or LGV. In the past few decades, LGV has been uncommon in industrialized nations, although several cases have recently been found in the Netherlands and the United Kingdom. To date, CDC -- which is coordinating a national investigation -- has confirmed 6 recent cases in the USA, including the 2 announced today, and cases in San Francisco (3) and Atlanta (1). CDC is also investigating other potential cases. The illness appears to have primarily affected gay and bisexual men.
Among cases identified thus far, most have also had HIV/AIDS infection. Most people infected report having multiple sex partners and engaging in unprotected anal intercourse and other high-risk practices. Symptoms of LGV include painful, bloody rectal infection that may be confused with inflammatory bowel disease. Genital ulcers can occur, as can painful, draining lymph nodes in the groin area. If identified early, LGV can be treated with antimicrobial agents. Untreated LGV can cause permanent damage to the bowels and disfigurement of the genitals (elephantiasis). LGV can also fuel the spread of HIV/AIDS.
At a press conference in lower Manhattan, Health Commissioner Thomas R. Frieden said, "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. Medical providers who care for gay and bisexual men should be alert for symptoms of LGV. It is also critical for gay and bisexual men to minimize risky sexual behaviors and practice safer sex -- including limiting the number of sex partners and using condoms every time you have sex -- to help prevent the spread of this illness and HIV/AIDS. Unprotected anal intercourse, in particular, is extremely risky in terms of spread of LGV as well as HIV."
Information about lymphogranuloma venereum (LGV) in NYC
LGV can cause acute illness and, while it can be treated, it can lead to life-long disability and disfigurement and fuel the spread of HIV/AIDS.
Symptoms include genital lesions or painful draining lymph nodes in the groin area, pain in the rectum and bloody diarrhea. Infection is slow to heal and can lead to recurring infections.
LGV is difficult to definitively diagnose. Commercially available testing does not reliably distinguish between different Chlamydia strains; definitive testing is currently available through CDC (which is how the New York City cases were diagnosed).
Cases of LGV are uncommon but do occur each year in the USA. In 2004, ProMED posted cases in Texas and California.
The LGV organism gains entrance through skin breaks or abrasions, or crosses the epithelial cells of mucous membranes. Traveling via the lymphatics, it multiplies within mononuclear phagocytes in the regional lymph nodes. Transmission is predominantly sexual. However, transmission by fomites, nonsexual personal contact, or laboratory accidents has been documented. The creation of aerosols has been associated with infection associated with pulmonary symptoms.
The disease occurs in 3 stages. The majority of infections in the primary and secondary stages may go undetected. The primary stage is marked by the formation of a painless herpetiform ulceration at the site of inoculation. The secondary stage classically is described as the inguinal syndrome, and it is characterized by painful inguinal lymphadenitis and associated constitutional symptoms:
Tender inguinal lymphadenopathy, usually unilateral, is the most common clinical manifestation.
Heterosexual men are affected most often in the inguinal lymph nodes.
Homosexual men and women who are receptive to anal sex may develop perirectal and pelvic lymph node involvement. In women, these nodes may be involved as a result of lymphatic spread from the cervix and posterior vaginal wall.
Suppurative granulomatous lymphadenitis and perilymphadenitis occur over time with matting of the nodes. Frequently, these nodes coalesce to form stellate abscesses. Histologically, these abscesses are nearly diagnostic, but they may be similar to those seen in other infections, including cat scratch fever and mycobacterial granulomatous infections.
The tertiary stage of LGV occurs years after the initial infection. In this stage, an anogenitorectal syndrome may occur, with resultant rectal stricture or elephantiasis of the genitalia. This syndrome is found predominantly in women and homosexual men, because of the location of the involved lymphatics. This late stage is characterized by proctocolitis, which is caused by hyperplasia of intestinal and perirectal lymphatic tissue. This inflammation forms perirectal abscesses, ischiorectal abscesses, rectovaginal fistulas, anal fistulas, and rectal stricture. In very late stages, fibrosis and granulomas are characteristic. Chlamydial organisms are scarce at this stage. - Mod.LL
Patricia A. Doyle, PhD
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