Lymphogranuloma venereum outbreak in Europe

Abstract

Lymphogranuloma venereum (LGV) is a venereal disease caused by Chlamydia trachomatis biovars L1 to L3. Unlike other anogenital C. trachomatis infections, LGV preferably affects lymphatic tissue after invasion through an epithelial surface. LGV has been considered an exotic tropical disease in Europe. This changed in 2003 as there was an outbreak of LGV in Rotterdam followed by additional reports from other European countries and North America. Most patients were HIV-positive men who presented with proctitis. Most of these patients were infected by C. trachomatis L2b biovar, a variant that was first identified in patients from Amsterdam. This review will address the recent developments of the LGV outbreak in Europe and discuss epidemiology, clinical manifestations, new subtypes of LGV genotypes and appropriate diagnostic measures.

Development and Evaluation of anompAQuantitative Real-Time PCR Assay forChlamydia trachomatisSerovar Determination

“…Outbreaks of LGV serovar L2, and in particular LGV biovar L2b, throughout Europe since 2003 have highlighted the importance of C. trachomatis serovar identification (28). The LGV outbreak has occurred predominantly among high-risk MSM populations, including HIV-positive individuals (23), whose presence has been noted in Australia (22). Given the significance of LGV serovars and the severity of their associated disease, close monitoring for early detection is considered highly relevant.…”

Sexually Transmitted Infections (STI) in Men Who Have Sex with Men (MSM)

“…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).…”

“…Finally, the high and increasing prevalence of longstanding and well-treated HIV infection among MSM contributes to a continuously changing epidemiology, exemplified by the increase in syphilis since 1999 [7][8][9][10][11], the recent reappearance of LGV (variant L2b) [12] and the increase in sexually transmitted Hepatitis C [13].…”

Introductory Chapter: The Latest Knowledge

“…Although the disease is endemic in East and West Africa, India, Southeast Asia, and the Caribbean, it is less common in Europe [18]. Also, LGV is traditionally described as "a sporadic disease" in North America, Europe, and Oceania, but highly prevalent in parts of Africa, Asia, and South America [19,20].…”