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Knight Ridder Newspapers
(KRT)
PHILADELPHIA - A sexually transmitted disease that few American physicians know about is becoming a problem in Europe and the United States, especially among gay and bisexual men, public health officials say.
Lymphogranuloma venereum, or LGV, is caused by a particularly invasive type of chlamydia bacteria that commercial lab tests cannot identify. While LGV can be treated with antibiotics, its early symptoms - including constipation, rectal pain and discharge - are easily misdiagnosed.
Left untreated, it can cause permanent damage to the bowels and disfigurement of the genitals.
Last November, the U.S. Centers for Disease Control and Prevention began trying to raise awareness and evaluate the prevalence of LGV by asking clinicians to report suspected infections to health departments and CDC, even though national reporting is not mandated. Since then, six men, most HIV positive, have been diagnosed by CDC lab analysis - three in San Francisco, one in Atlanta, and two in New York City.
"Getting the word out to healthcare providers and patients is really important," epidemiologist Catherine McLean of the CDC's STD prevention division said this week.
The New York City cases, announced in February, prompted Philadelphia's Department of Public Health to send an advisory to AIDS prevention groups and clinics.
No cases have been found yet in Philadelphia, health department spokesman Jeff Moran said. But "with travel, nothing stays in one place very long," said Gary Bell, executive director of Philadelphia-based BEBASHI (Blacks Educating Blacks About Sexual Health Issues), who attended a health department meeting last month at which LGV was discussed.
Bell cautioned against sensationalizing or hyping the threat of LGV, but said raising awareness is prudent because it "is not on the radar screen."
Identified by pathologists almost 100 years ago, LGV blipped onto this country's public health radar screen in the late 1970s and early 1980s, when it was called "gay bowel syndrome," said Johns Hopkins University infectious disease expert Jonathan Zenilman.
"It almost disappeared after the early 1980s because of safer sex practices" and AIDS awareness, he said.
LGV remains common in parts of Africa, Asia, South America and the Caribbean, where public health systems are weak.
The recent spread in developed countries is being fueled by high-risk sexual behavior among gay and bi-sexual men, most of them HIV positive, health officials say. This population also has had increases in syphilis, rectal gonorrhea, and antibiotic-resistant gonorrhea in recent years.
"Diseases like this make it important to strive for 100 percent safe sex," Dennis DeLeon, president of New York City's Latino Commission on AIDS, said last month at a news conference announcing that city's LGV cases.
LGV became a concern of Western health officials about a year ago when an outbreak occurred in the Netherlands, eventually involving more than 100 gay men, most HIV positive. Similar outbreaks were soon recognized in Antwerp, Hamburg and Paris.
About 34 cases of LGV have been reported recently in the United Kingdom, according to an article in the current British Medical Journal.
"It is likely that LGV has been present for some time in men who have sex with men in the United Kingdom, with many cases going undiagnosed," the authors conclude.
Chlamydia is the most common sexually transmitted infection, with an estimated 4 million new cases annually in the United States alone. However, the well-known, common types of chlamydia cause only mild or asymptomatic infection in early stages, while the type that causes LGV causes acute illness and spreads to lymph nodes if left unchecked.
The CDC is urging doctors who suspect a case to prescribe three weeks of antibiotics without waiting for a definitive diagnosis from the CDC or another special lab.
"We're trying to get the word out that those symptoms may be associated with an STD, in particular LGV," McLean said.
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(c) 2005, The Philadelphia Inquirer. Distributed by Knight Ridder/Tribune News Service.
