Over 300 cases of the sexually transmitted infection (STI) lymphogranuloma venereum (LGV) have been diagnosed in the United Kingdom, according to figures presented to a sexual health conference on May 10th. Nearly all the cases involved gay men, many of whom were HIV-positive. Co-infection with other sexually transmitted infections such as hepatitis C virus, was also common.
LGV is a form of chlamydia, and although endemic in many parts of the world, it was rarely seen in Europe and North America after the introduction of antibiotics. However, in 2004 a cluster of LGV infections was seen amongst gay men who had attended sex parties in the Netherlands. The infection was quickly disseminated across western Europe and cases have also been reported in the United States.
In October 2004, enhanced national surveillance of LGV was commenced in the United Kingdom and investigators from Imperial College, University of London, presented data on the epidemiology of the infection in the United Kingdom, based upon reports received until the end of March 2006.
The investigators reported that a total of 341 cases of LGV had been diagnosed in the United Kingdom with detailed information being available for 283 cases. All but three of these cases involved gay men. The LGV epidemic was focused in London, where almost three quarters of infections were located. A secondary focus of the infections was Brighton (14%), with the remaining cases distributed across the country.
Most patients (94%) presented with symptoms of inflammation of the rectum (proctitis), although 30% also had flu-like symptoms and in a small proportion of individuals (3%) the infection was silent.
The median time between the onset of symptoms and presentation at a sexual health clinic was 13 days, although this time varied considerably between individuals from less than one day to over 18 months.
HIV was present in 76% of men diagnosed with LGV, including nine men who were diagnosed with HIV at the same time as LGV. Fewer than 50% of HIV-positive men diagnosed with LGV were taking potent anti-HIV therapy and were therefore more likely to transmit HIV to others. A significant level of hepatitis C coinfection (11%) was also observed amongst HIV-positive gay men with LGV. Other sexually transmitted infections were present in 26% of the men.
Unprotected anal sex and fisting have been identified as risk activities for hepatits C transmission amongst men with HIV. Data from other European countries indicate that LGV is also disproportionately affecting HIV-positive gay men who have unprotected sex and who are involved in “hard” sex scenes and fisting.
Data were also gathered on the places where men with LGV were meeting their sexual partners. Sex parties and sex clubs were frequented by 71% of men diagnosed with LGV in the United Kingdom, and 26% of men also said that they had met partners online.
There is evidence that the infection is moving out of its initial cluster of men who had sexual contacts with men involved in original outbreak in the Netherlands. Individuals diagnosed with LGV in 2004 were significantly more likely to report sexual contacts in or from the Netherlands than those diagnosed in 2005 and 2006 (20 vs. 3%, p = 0.002).
“There is a sustained outbreak of LGV amongst gay men in the United Kingdom”, conclude the investigators, who emphasise the overlap with HIV and other sexually transmitted infections.
Anecdotal reports also suggest that LGV is continuing to spread amongst HIV-positive gay men. The Kobler Centre at the Chelsea and Westminster Hospital in London, the largest HIV treatment centre in the United Kingdom, is reportedly diagnosing ten new cases of LGV infection a week.