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Lymphogranuloma venereum in British Columbia

An increase in Lymphogranuloma venereum (LGV) cases was identified in 2011 in BC.  LGV is a sexually transmitted infection and is caused by three types of Chlamydia infection.  The clinical presentation of people with LGV includes papules (raised surface or bumps), lesions, and swollen lymph nodes in the genital area. LGV can also cause rectal ulcers, bleeding, pain and discharge (particularly if someone has had receptive anal sex).  If untreated, serious complications can develop (such as enlargement and ulceration of the external genitals, and lymphatic obstruction).  Because the symptoms of LGV can mimic other STIs or gastrointestinal diseases, LGV may be easily misdiagnosed.  While more common in Central and South America, LGV has now emerged as an STI that predominantly affects gay, bisexual and other men who have sex with men (MSM) in North America and Europe.

In 2011, 21 cases of LGV were identified in BC, all in MSM most of whom were HIV positive.  The increase is in part related to increased detection of cases, as the Provincial Public Health Reference and Microbiology Laboratory began routinely testing all positive rectal Chlamydia infections for LGV in early 2011.  However it is possible that the increase also reflects a true increase in transmission.  Several recent reports from Europe have also indicated an increase in LGV rates during this period.

Clinicians need to consider a diagnosis of LGV among their MSM patients with compatible symptoms.  LGV requires longer antibiotic treatment than other Chlamydia infections, and a test of cure is recommended.  LGV is still a relatively uncommon infection in BC, and other STIs such as gonorrhea, non-LGV Chlamydia, and syphilis are more common among MSM.   Regular STI and HIV testing for all STIs and HIV among sexually active MSM are recommended (including rectal STI testing for MSM having receptive anal sex).

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Acknowledgements:  Monka Lindegger, Travis Salway-Hottes