The Health Protection Agency for England has initiated enhanced surveillance measures for the sexually transmitted infection lymphogranuloma venereum (LGV). The move comes after several sexual health clinics reported increased numbers of cases of proctitis, one of the main symptoms seen in the current outbreak of LGV across Europe. Public health officials are hoping that their actions will improve the diagnosis and control of LGV amongst gay men.
A series of outbreaks of LGV have been reported amongst gay men across Europe since December 2003. So far clusters have been identified in Rotterdam (92 cases), Antwerp (27 cases), Paris (38 cases), and cases have also been confirmed in Stockholm and Hamburg. These outbreaks have been concentrated in sexual networks of gay men and appear to be associated with sex parties which have attracted men from across Europe.
Cases of the infection, which is a form of Chlamydia, have been rare in Europe since antibiotics became available, however, it is endemic in parts of Africa, Asia, South America and the Caribbean. It can be successfully treated by 21 days of oral doxycycline.
In the current European outbreak, cases have been confined to gay men, most of whom are white, and HIV-positive. Many of these men have also had a concurrent sexually transmitted infection including syphilis, gonorrhoea, herpes, and hepatitis B and C viruses. The Rotterdam outbreak in particular has been associated with the sexual transmission of hepatitis C.
Enhanced surveillance of LGV in the UK is intended to develop a clear LGV case definition of the disease, raise awareness of LGV amongst doctors, nurses and public health professionals and gay men, improve case detection in gay men, and establish genotyping of Chlamydia as the key laboratory diagnostic tool.
Across Europe, the majority of men with LGV have presented with proctitis. In a report published on the outbreak in the Netherlands (reported on aidsmap.com), the investigators speculated that this could be because the outbreak was related to fisting. Fisting has also been identified as a risk factor for the sexual transmission of hepatitis C amongst gay men in outbreaks across Europe, and the evidence from Rotterdam where LGV, hepatitis C and fisting are linked is consistent with this.
Investigators are concerned that the sex parties linked to the LGV clusters attracted gay men from across Europe, including the UK. All the cases identified so far have involved infection with the L2 genotype of LGV and there is no evidence that the infection has spread beyond a limited subgroup of gay men.
Details of enhanced surveillance, including the current case definition, laboratory referral request forms and outbreak questionnaire can be found at the Health Protection Agency website.