More symptom awareness and improved testing methods required to stem tide of growing LGV epidemic

Europe-wide LGV prevention and control efforts need to be urgently improved, according to an update on the state of the current LGV epidemic in the June 2^nd issue of the online publication Eurosurveillance Weekly. The LGV epidemic is of “public health importance,” the authors suggest, “since LGV facilitates transmission of HIV and other blood-borne infections.”

LGV is a sexually transmitted infection (STI) caused by the bacterium Chlamydia trachomatis, serovar L2, that is predominantly affecting HIV-positive gay men in north-western Europe, although cases have also been reported elsewhere in Europe, as well as in the United States and Canada. Symptoms of LGV proctitis include rectal pain, discharge and bloody stools, although uthethral LGV may be symptom-free.

Three years after symptoms of LGV were first reported by patients in the Netherlands and France, diagnosis of this STI can still be missed. This is often due to both doctors’ and patients’ lack of familiarity with signs and symptoms of LGV. Other reason for the epidemic, the report notes, is the continued “lack of licensed chlamydia polymerase chain reaction (PCR) tests for rectal specimens and genotyping facilities. Reporting LGV is not mandatory in many countries and new cases have often not been reported in a timely way.”

At a scientific meeting in April 2005 organised by the European Surveillance of Sexually Transmitted Infections (ESSTI) and the Dutch National Institute of Public Health and the Environment (RIVM), the following recommendations were made in order to improve Europe-wide LGV prevention and control efforts:

• Clinical recognition still needs to be improved by increasing awareness of sexually transmitted infections among general physicians.
• Updated clinical information and guidance for investigation (including standardised questionnaires), diagnosis and management should be placed on the ESSTI website.
• International comparison of strains is required. More information-sharing among European microbiologists would be beneficial.
• An Europe-wide accepted case definition and international recommendations for standard diagnostic methods are needed as quickly as possible.
• ESSTI should publish a list of reference laboratories competent at confirming LGV diagnosis.
• International internet-based anonymous reporting of LGV-cases (real-time surveillance) should be considered.
• A multi-centre study on epidemic characteristics and clinical features of LGV proctitis among MSM should be considered.
• There is a continuing need for targeted interventions to improve the sexual health of gay and bisexual men.

In addition, since European countries are not equally affected by the LGV epidemics, it was recommended that:

• In countries with no or few reported cases at present, more awareness of LGV is needed amongst gay and bisexual men. Clinicians need information about the clinical features of LGV, diagnostics and methods of reporting. These countries should begin to identify laboratory diagnostic facilities and reference centres.
• In countries with a number of reported cases, active surveillance should be implemented and the transmission risk factors and clinical features need to be investigated thoroughly. International collaboration should increase the power of descriptive and analytic investigations.

According to data from March 2005, there have now been a total of 144 confirmed cases in the Netherlands, the majority of which have been in Amsterdam. In France, 142 cases of LGV have been confirmed, mainly in Paris and Bordeaux. Last month, aidsmap reported that there had been 67 confirmed cases in the United Kingdom. An update from the HPA several weeks later increased the number of confirmed cases to 72. Small clusters of cases have also been reported in Germany, Belgium, Sweden, Spain, the United States and Canada.