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Lymphogranuloma venereum

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VOL: 101, ISSUE: 36, PAGE NO: 31

What is it?


What is it?
- Lymphogranuloma venereum (LGV) is a sexually transmitted disease caused by a specific type of the bacterium Chlamydia trachomatis (serovars L1, L2, and L3). Unlike other forms of C. trachomatis, LGV is invasive and affects the lymphatic system.



- Since 2003, a series of outbreaks of LGV have been reported in European cities among men who have sex with men.



Risk factors
- The main risk factor is having multiple sexual partners.



- Around 80 per cent of men diagnosed with LGV are also HIV-positive.



- About 3-21 days after becoming infected, a primary lesion may be found in the form of a painless papule, pustule or shallow erosion. However, most of the time this symptom goes unnoticed.



- In the second stage, about 10-30 days later, there is fever and a general feeling of illness and painful, enlarged glands near the site of infection. The symptoms at this stage are dependent on the infection site: in the rectum they include altered bowel movements and a rectal discharge of pus or blood; in the penis they include urethritis and swollen glands in the groin.



- In the tertiary stage, as a result of scarring and tissue damage from years of inflammation, there will be destruction of tissue in the involved areas, including: proctitis, acute proctocolitis mimicking Crohn’s disease, fistulae, strictures and chronic granulomatosis.



- In response to the reports of outbreaks in Europe, the Health Protection Agency launched an initiative in October 2004 to improve LGV case ascertainment and awareness in the UK. More than 140 cases of LGV were confirmed between October 2004 and 26 July 2005 and numbers will continue to increase as samples are processed (HPA, 2005).



- Most cases have been seen in clinics in London (69 per cent), followed by Brighton (14 per cent), other cities across England (12 per cent), and Scotland (4 per cent) (HPA, 2005).



- A few thousand cases of LGV are seen each year in the US and it is highly prevalent in parts of Africa, Asia and South America.



- A three-week course of oral doxycycline is the commonest treatment regime (BASHH, 2001).



- Treatment at the second stage is normally effective in preventing progression to stage three.



- Condoms and latex gloves are recommended as an effective and cheap means of prevention.



- The Terrence Higgins Trust has launched an internet-based information campaign to ensure that men who have sex with men are aware of LGV, recognise the symptoms and get treatment.



- Sexual health clinics, particularly those that care for HIV-positive men, should obtain supplies of the Terrence Higgins Trust’s LGV information leaflet (Terrence Higgins Trust, 2005)

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