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LGV and shigellosis
Cases of two unusual sexually transmitted infections have been seen in recent months. Many of these cases have involved HIV-positive gay men.
LGV
LGV is short for Lymphogranuloma venereum; it is a form of the common sexually transmitted infection Chlamydia.
LGV is very common in Africa, Asia, South America and parts of the Caribbean. However, with the introduction of antibiotics in the 1940s, LGV became very rare in the UK and Europe.
However, outbreaks of LGV have recently been reported in gay men in the Netherlands, France, Germany, the US and Sweden. In the UK, measures have been introduced to detect and monitor any outbreak. By early February 2005, 25 cases have been identified in England (mostly in London), all involving gay men, most of whom were HIV-positive.
Transmission of LGV
Although the current outbreak of LGV in Europe has involved gay men (most of whom have been HIV-positive), LGV can affect both men and women regardless of their HIV status.
LGV can affect the penis, vagina and anus, and can be passed on during unprotected (sex without a condom) anal, oral and vaginal sex.
The cases seen in European gay men recently have all involved the anus and rectum, and it is thought that they are linked to fisting, as none of the men had LGV infection in their penis. However, some of the men with anal and rectal infection with LGV said that they had never been fisted, but had had unprotected anal sex.
The cases of LGV seen so far have been in clusters. It is known that many of the cases were linked with fisting sex parties that took place in the Netherlands. Many of the men who attended these parties were HIV-positive.
Most of the men diagnosed with LGV in the European outbreak also had another sexually transmitted infection such as gonorrhoea, syphilis, herpes, hepatitis B virus and hepatitis C virus.
Condoms are very effective at preventing the transmission of sexually transmitted infections, including Chlamydia, of which LGV is a form.
If you are fisting, wearing latex gloves and not sharing pots of lubricant can help prevent the transmission of LGV and other sexually transmitted infections.
Symptoms of LGV
LGV can cause very unpleasant symptoms. In the current outbreak, the commonest symptom has been proctitis – pain and inflammation in the anus and rectum. In some cases this has been accompanied by swollen glands in the groin, and often by a discharge of mucus from the rectum (which can be bloody), and constipation.
If left untreated, LGV can cause general swelling of the lymph glands, extreme swelling of the genitals, ulcers on the genitals. It can affect the bowels, and can cause a fistula.
Because it is so rarely seen, some of the recent cases of LGV in Europe were initially misdiagnosed as another sexually transmitted infection, such as syphilis or herpes, or as Crohn’s disease. However, sexual health and HIV clinics across the UK have been alerted to the outbreak of LGV and its symptoms and are becoming more skilled at recognising it.
Diagnosis of LGV
If you go for a general sexual health check-up, you will be screened for a number of sexually transmitted infections. If you are found to have Chlamydia in the anus the clinic should send the sample for special tests to see if is LGV.
If you are concerned that you might have LGV, make sure that you tell the doctors or nurses at the clinic you are attending.
Treatment of LGV
LGV can be cured using a 21-day course of the oral antibiotic doxycycline. This antibiotic is also used to treat other sexually transmitted infections (and some other infections), but in shorter courses.
It is important that you do not have sex if you have LGV, or any other sexually transmitted infection, until follow-up tests confirm that you have been cured.
Shigellosis
A small outbreak of another infection, shigellosis, which can be transmitted during sex, has also been reported in London. Similar outbreaks have also been reported in the US, the Netherlands, Australia and Germany.
Shigellosis is caused by a bacterium called Shigella sonnei which is highly infectious, regardless of whether or not a person has HIV and can cause severe diarrhoea. Symptoms can be worse in HIV-positive people who have weakened immune systems.
Shigella is transmitted by contact with very small amounts of human faeces (shit). This can occur as a consequence of poor hygiene, or during sex. Rimming, fingering, fisting, anal sex, handling sex toys after use in the anus, and occasionally oral sex can all carry a risk.
It makes good sense to wash your hands after sex, after using the toilet and before preparing food.
If you have severe diarrhoea you should see your doctor as soon as possible, who will check a faeces sample for shigella. It can be successfully treated with antibiotics.