Genital ulcers and swelling in the groin may be unusual symptoms of the sexually transmitted infection lymphogranuloma venererum (LGV), caution UK doctors in an article published in the online edition of Sexually Transmitted Infections.
LGV is a bacterial sexually transmitted infection and is endemic in Africa, the Caribbean and parts of Asia. It became very rare in the UK following the introduction of antibiotics. However, since 2004 the infection has reappeared in the UK, several other European countries and the US. Most of these cases of LGV have involved HIV-positive gay men. Many of these men were also diagnosed with other sexually transmitted infections, notably hepatitis C, at the same time as LGV.
To date, most of these LGV infections in gay men have involved symptoms of proctititis. There have been few cases involving ulcers on the genitals or around the anus, or swellings in the groin, the classic symptoms of the infection.
However, doctors from three large sexual health clinics in London have now reported a series of thirteen cases of LGV infection in gay men, the symptoms of which differ from those reported in the outbreak among men who have sex with men (MSM) since 2004 and which have more in common with the `classic` symptoms.
Only three of these thirteen cases involved men with HIV and none of the men was infected with hepatitis C.
All but one of the men presented with swellings in the groin. Four men also had genital ulcers at this time.
Of note, five of the cases involved urethral LGV infection, which was accompanied by large swellings in the groin. None of these men reported having any ulcers.
Six of the men said that they had only had one sexual partner in the previous three months. The partners of three of these men were HIV-positive. Subsequent LGV testing of one of these men found asymptomatic rectal infection.
The infection was successfully treated in all the men using a long course of the antibiotics doxycycline or azithromycin.
There was however a ten-month delay in diagnosing LGV in one patient. He first presented in December 2003 with a tender swelling in his right groin. He reported unprotected insertive and receptive anal sex with multiple anonymous partners. Treatment with amoxicillin and flucoxacillin was provided. The swelling in the groin ruptured and discharged pus for several months. The patient then started to pass blood from his rectum and lose weight. Infection with LGV was only diagnosed when the patient had a colonoscopy. He then received standard treatment for the infection, 21 days of doxycyline.
“The cases described in this series differ epidemiologically from the typical LGV proctitis cases seen thus far in the UK men who have sex with men epidemic”, write the investigators.
“LGV…should be considered in the differential diagnoses of proctitis, anogenital ulceration and inguinal lymphadenoparthy [swollen glands in the groin], particularly in men who have sex with men,” conclude the investigators.