- From ProMED-mail
- Source: New York City Dept of Health & Mental Hygiene
Press Release http://www.nyc.gov/html/doh/html/public/press05/pr011-05.html
- 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
- 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
- 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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