Lymphogranuloma venereum: an emerging cause of proctitis in men who have sex with men

Abstract

Before 2003, lymphogranuloma venereum (LGV) was rare in developed nations. Several large clusters of LGV in men who have sex with men have been reported across Europe and in the United States of America (USA) since 2003. LGV is caused by L1, L2 and L3 serovars of Chlamydia trachomatis and is a sexually transmitted infection. LGV causes genital ulcers, infected inguinal lymph nodes (buboes) and proctitis/proctocolitis. Treatment with a three-week course of doxycycline prevents rectal strictures, bowel obstruction, bowel perforation and possibly death. Clinicians seeing men who have sex with men with inguinal lymphadenopathy and bowel symptoms should be aware of this current epidemic.

Sexually Transmitted Infections (STI) in Men Who Have Sex with Men (MSM)~!2009-08-10~!2009-09-28~!2009-12-24~!

“…As early as 1981- 83 LGV was associated with severe proctitis [41], one case presenting with massive rectal bleeding [42]. Although urethral/penile LGV presenting with ulcers has been reported, severe painful ulcerative purulent proctitis with rectal discharge, urge to defecate, tenesmus and the passage of blood are frequently the dominating symptoms of LGV [49]. Untreated chronic LGV may lead to abscesses that may rupture, severe perianal fistulas, genital elephantiasis, strictures and fibroses and may resemble Crohn's disease, although the appearance is non-specific [49].…”

“…Untreated chronic LGV may lead to abscesses that may rupture, severe perianal fistulas, genital elephantiasis, strictures and fibroses and may resemble Crohn's disease, although the appearance is non-specific [49]. The local lymph nodes are involved with pain, swelling, necrosis and perforation [12,49]. Since the recognition of the ongoing outbreak of LGV among MSM in Rotterdam, Holland [50], infections have been reported from many parts of Europe, North America and Australia [12,31,49] and LGV has become endemic among MSM in some areas of the UK [3].…”

“…The local lymph nodes are involved with pain, swelling, necrosis and perforation [12,49]. Since the recognition of the ongoing outbreak of LGV among MSM in Rotterdam, Holland [50], infections have been reported from many parts of Europe, North America and Australia [12,31,49] and LGV has become endemic among MSM in some areas of the UK [3]. From our experiences 14-16% of patients with symptomatic rectal chlamydia had LGV, a figure increasing to 30% in the case of HIV-positive patients [19] (Table 2c).…”

A comparison of two methods for the diagnosis of lymphogranuloma venereum

“…Although LGV symptoms can vary according to site of entry and stage of infection, genital ulceration and inguinal lymphadenopathy are the classical presentations of this disease. However, during the recent European MSM outbreak, anorectal symptoms were the most common presentation, making syndromic management problematic (van de Laar, 2006;Richardson & Goldmeier, 2007).…”

Linfogranuloma venério: aumento na incidência sugere surto mundial da doença

“…4 Com os diversos dados atuais mostrando surtos em países desenvolvidos, as autoridades de saúde devem estar atentas para a ocorrência de novos casos doença e rastreamento dos parceiros sexuais. 19 Pela falta de um teste diagnóstico rápido e de uso difundido, os doentes com quadros sugestivos de LGV devem receber terapia antimicrobiana durante pelo menos três semanas. 12 Há autores fazendo a mesma recomendação nas retites detectadas durante a…”