Ottawa Public Health (OPH) is warning men who have sex with men (MSM) that cases of an aggressive subtype of chlamydia are on the rise.
Before 2003, cases of lymphogranuloma venereum (LGV) were limited to parts of Africa and the Caribbean, says Gila Metz, medical director of the Healthy Sexuality and Risk Reduction Unit at OPH. Then, an outbreak of LGV among MSM in the Netherlands spread to North America.
Metz says a recent increase of LGV cases in Montreal and Gatineau led doctors in Ottawa to look at the infection rates in Ottawa more closely. However, Metz does not consider LGV in Ottawa an “outbreak” or “epidemic” yet.
“As far as we can tell, it looks like an increase,” she says. “The problem with some of the terminology is we don’t have a good sense of the baseline because it hadn’t been tracked. We’re still dealing with a small number of cases at this point, so we’re looking at an increase.”
If a man is infected with urethral LGV, lymph nodes in the pubic region swell painfully and flulike symptoms may be present. But, Metz says, the majority of cases in Ottawa are rectal infections.
With a rectal infection, the rectum becomes inflamed, along with ulcers, bleeding, constipation and mucus discharge as potential symptoms, Metz says.
“We know that very likely there has to be urethral infections that probably aren’t symptomatic,” she adds. “That’s something that we’re looking into a bit more now.”
Currently, only symptomatic patients, or anyone who has had contact with an LGV carrier, are tested for LGV.
But Metz says this approach could change, and in the future anyone who tests positive for “garden variety” chlamydia may have their results sent for serotyping to check for LGV.
Metz notes that studies show 75 to 80 percent of men with LGV are also HIV-positive.
Treatment of LGV consists of a longer cycle of the same “front-line antibiotics” prescribed for common chlamydia, Metz says.
Condoms are “quite effective in deterring the transmission of all STIs,” she says, but depending on the progression of an LGV infection, transmission through skin-to-skin contact is also an infinitesimal possibility.