The number of gay men infected with the sexually transmitted infection lymphogranuloma venereum (LGV)
has almost tripled in one year, and the UK now has the world’s worst
epidemic of LGV, the Health Protection Agency reported today. At the
same time, the agency is tracking an outbreak in gay men of shigellosis, a bacterial infection that is transmitted through contact with tiny amounts of human faeces.
HPA suspects that transmission of both infections is being fuelled by
serosorting behaviour, in other words men choosing to have unprotected
sex with men who have the same HIV status as themselves. While
HIV-positive men who serosort may avoid passing on their HIV infection,
they still risk acquiring unpleasant and often serious sexually
transmitted infections such as LGV, shigella and hepatitis C.
Serosorting “is unsafe”, the HPA says.
LGV is a previously rare sexually transmitted infection, seen in UK gay men since 2003. It is caused by specific strains of Chlamydia. If left untreated, symptoms can be complex and severe, including proctitis (inflammation of the anus or rectum).
of LGV increased from 190 in 2009 to 530 in 2010. Of the total 1560
cases seen between 2003 and 2010, more than one third have been
diagnosed since the beginning of 2010.
vast majority (83%) of LGV cases were in HIV-positive gay men. The
infection is thought to be transmissible during unprotected anal
intercourse, an activity which 84% of infected men report. Two-thirds of
diagnoses were in London, but there are cases from across the country,
especially Brighton and Manchester.
The public health agency is also concerned about a smaller outbreak of shigellosis. This bacterial infection, caused by either Shigella sonnei or Shigella flexneri has
only occasionally been seen in UK gay men. The symptoms of shigellosis
can include severe and bloody diarrhoea, but it can be successfully
treated with antibiotics.
is transmitted by contact with tiny amounts of faeces. This can occur
as a consequence of poor hygiene, or may be linked to sex, especially
rimming, fingering, fisting, anal sex, and handling used sex toys and
douching equipment. The bacteria may pass from dirty fingers to the
mouth; basic hygiene and handwashing habits reduce the risk of
There have been 29 cases of infection with Shigella flexneri recorded
since May 2011, mostly in London or Manchester. The HPA have not yet
identified the key characteristics of the men who have been infected or
identified the shared use of specific venues. However some previous
shigellosis outbreaks have been concentrated in men with HIV and in men
who used sex-on-premises venues.
HPA report also notes the ongoing epidemic of sexually acquired
hepatitis C in gay and bisexual men with HIV - 228 cases of recent
infection were recorded at 22 of the larger HIV clinics in 2008-2010.
addition, new diagnoses of the more widespread infections chlamydia and
gonorrhoea are higher than they have been for more than a decade, at
around 4500 and 5000 diagnoses respectively.
HPA believes these figures highlight the dangers for HIV-positive men
of ‘serosorting’, in other words having unprotected sex with partners
thought also to be HIV-positive. “Serosorting poses a risk of acquiring
other STIs and hepatitis, with serious treatment implications,” the
does not encourage HIV-negative men to serosort either, because rates
of undiagnosed HIV are high. One quarter of those infected do not know
that they have HIV.