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22 LGV cases in Canada: report

Treatable infection spreading among gay men

The disease is new, but the means of prevention is a tired refrain: Condoms, condoms, condoms.

In our connected world it was only a matter of time before lymphogranuloma venereum (LGV) hit Canada. Last month, the Public Health Agency Of Canada (PHAC) reported 16 confirmed and six probable cases of LGV in this country. Last November there were no cases in Canada.

It’s likely not just 22 cases.

“Because the process is so long to get results there may be more. I think I know of more,” says Leo Mitterni, the Hassle Free Clinic’s men’s clinic coordinator. The clinic has to send blood tests to the PHAC laboratory in Winnipeg for diagnosis, which can take up to six weeks.

LGV is caused by a type of chlamydia that is prevalent in Africa, Asia, South America and the Caribbean, but until now rare in Western Europe and North America. Most of the patients in West Europe and North America have been sexually active gay men.

LGV is treatable, but when left untreated there can be serious complications such as destruction of the genitals or rectum and even death. LGV first causes small lesions on and around the genitals. Secondary symptoms are more pronounced and include swollen lymph nodes. Other symptoms include pain while urinating, fever, malaise and headaches. In some cases patients have developed gastrointestinal bleeding.

Condom use would protect against LGV, not to mention the panoply of other STDs floating around. Most of the Canadian cases are believed to have been spread by unprotected anal sex.

Mitterni says they have seen six or seven cases of LGV just at Hassle Free. PHAC declined to tell Xtra how many of the 22 cases were in Toronto, or even Ontario.

“We don’t have the permission of the provinces and territories to disclose that information,” says PHAC media relations officer Jean-Mathieu Dion.

Of the 13 Canadian cases for which the date of symptom onset is known, half were in February and March of this year. Is it possible there were undetected cases in Canada as early as 2004?

“At that time we weren’t thinking LGV,” Mitterni says. “There were a couple cases where we were questioning what was going on, but because we weren’t thinking LGV…. Now it is more in everybody’s thought.”

In February of this year PHAC, in partnership with provincial health authorities, established a national surveillance system for LGV. While that system may find more cases by looking harder, Mitterni says that Toronto’s Hassle Free are actually not seeing as many cases now as in February.

“But I can only comment on us. It’s hard to say what’s going on out there,” he says. “There is a heightened sensitivity to it now that we are more open to looking for it.”

In the Netherlands in 2003 a cluster of cases emerged, which spread to other European countries. Some cases were later reported in San Francisco, and then New York. But of the 22 cases in Canada “none reported having had sex while travelling outside of Canada in this time frame,” stated an analysis published in Canadian Medical Association Journal last month.

Concurrent HIV infections were evident in 83 percent of reported cases; high risk behaviour such as fisting was common.

A Jun 1 Globe And Mail story suggested that LGV might be the “new AIDS.” Mitterni points out, “It’s an infection, but it’s treatable.” PHAC’s Dion says that although it’s important for Canadians to be aware of LGV, there is still a much higher risk for other STIs [sexually transmitted infections] such as chlamydia. Compared to the 22 cases of LGV in Canada, there were more than 58,000 reported cases of non-LGV chlamydia in Canada in 2003.

“We don’t want to target LGV only,” Dion says. “We want to target STIs as a whole.”