San Francisco Public Health Officials Issue Alert About Rare STD Appearing Among MSM

San Francisco public health officials on Monday issued a warning about a rare and "potentially debilitating" sexually transmitted disease -- called lymphogranuloma venereum, or LGV -- that has appeared in the city in four men who have unprotected sex with men, the San Francisco Chronicle reports (Russell, San Francisco Chronicle, 12/21). About 90 MSM in the Netherlands have been diagnosed with LGV, and officials have reported other cases in Belgium, France, Sweden and Britain. The infection is caused by a strain of the bacteria that causes chlamydia and can be cured with antibiotics. LGV is associated with genital ulcers and flu-like symptoms and can cause severe gastrointestinal distress. CDC officials in November warned doctors that LGV had been spreading among men who have unprotected sex with men in Europe and could appear among such men in the United States. LGV usually is seen in developing countries -- such as those in Africa, Southeast Asia and Latin America -- and most often is diagnosed among heterosexuals, in whom it causes genital lesions and swelling in the lymph glands in the groin. Men who experience rectal symptoms -- including bleeding of the rectum and colon -- most likely contract LGV through unprotected anal intercourse. Health professionals are concerned because the rectal inflammation and ulceration sometimes caused by LGV could increase the risk of transmitting or contracting HIV and other bloodborne diseases (Kaiser Daily HIV/AIDS Report, 11/9).

San Francisco Cases
Doctors at a city clinic in November treated one man for LGV, and through screening of past rectal chlamydia samples, subsequently found three other cases that occurred over the summer but had gone undetected, according to the Chronicle. None of the four men has visited the Netherlands, which may be an indicator that other cases in the city have not been detected, Dr. Sam Mitchell, a city Department of Public Health epidemiologist, said, the Chronicle reports. Some of the four men also are HIV-positive, but HIV-positive patients are not thought to be at a higher risk of LGV complications, Mitchell said, according to the Chronicle. Treatment for LGV requires a three-week course of antibiotics and successful treatment is possible if the disease is caught early, according to the Chronicle. "The idea is to knock it out quickly. If it circulates widely, it could be quite challenging," Mitchell said, adding that the city is recommending doctors treat all cases of rectal chlamydia with the three-week antibiotic regimen. "We think doctors should err on the side of caution," he said (San Francisco Chronicle, 12/21).