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I couldn't find any copyright notice, so I'm assuming it is okay to post this with the credit. If not, please Dude, remove it.

Bart

Risk factors identified for lesser-known STD in MSM

The CDC has developed a new, accurate, rapid diagnostic test for lymphogranuloma venereum.

by Tara Grassia

IDN Staff Writer

July 2006

Researchers have identified risk factors associated with lymphogranuloma venereum (LGV) among men who have sex with men (MSM) and a new method for detecting this sexually transmitted disease (STD), which could eventually aid in quicker detection and treatment of cases.

?Overall CDC laboratories have confirmed 30 LGV cases, but we do not know how many have been diagnosed by other laboratories. All cases were diagnosed among men and for the cases for which we have information on the gender of the sex partners, all have been among MSM, the majority of whom are HIV positive,? said John M. Douglas, Jr., MD, director of STD Prevention at the CDC?s National Center for HIV, STD and TB Prevention.

LGV is an STD caused by specific and invasive strains of Chlamydia trachomatis. LGV in developing countries is usually associated with an adenopathy syndrome with or without genital ulceration. In MSM, symptoms are usually manifested by gastrointestinal problems such as bleeding, inflammation of the colon and rectum; symptoms that are not normally associated with other STDs.

The STD is most prevalent in parts of Africa, Asia, and South America. Cases have been rarely diagnosed in the United States and Europe until health care officials noted recent outbreaks among MSM. While there are no data on the prevalence of LGV in the United States, researchers have reported cases from a number of geographically dispersed cities across the nation, Douglas explained at the 2006 National STD Prevention Conference.

Data from New York City presented at the conference provide the most detailed profile to date of the risk factors for LGV in MSM. These findings could ultimately help public health officials prevent, diagnose and treat the disease more effectively.

MSM at risk for LGV

Since late 2004, cases of LGV have been identified among MSM in several U.S. cities. New York City has had more suspected cases than any other city in the nation, according to Douglas. Health officials reported the first laboratory confirmed case in New York City in early 2005.

In order to attain a better understanding of those at risk, LGV prevalence in the city, and transmission patterns, researchers from the New York City Department of Health and Mental Hygiene and Bureau of STD Control conducted analyses on 249 specimens collected from suspected cases in 2004 and 2005. The researchers identified links between LGV, HIV and syphilis among MSM.

?Almost all specimens were from men, the majority of whom sought health care from private providers after experiencing rectal symptoms,? said Preeti Pathela, DrPH, MPH, of the New York City Department of Health and Mental Hygiene. ?Lab results showed that 31 patients tested positive for LGV.?

Pathela and colleagues reported that 97% of LGV cases detected occurred among MSM and 65% of those diagnosed with the disease reported unprotected receptive anal intercourse during the previous six months. Additionally, 84% of those with LGV were co-infected with HIV, and nearly half (48%) had a prior syphilis diagnosis.

To assist in developing LGV prevention strategies, the researchers compared behavioral and demographic data from ten men diagnosed with LGV to 247 diagnosed with syphilis.

?We found comparable profiles with respect to age, race/ethnicity, MSM, having anonymous partners, not discussing HIV status before sex and meeting partners on the Internet,? she said. ?We found no apparent epidemiological link to cases reported in Europe, despite the similarity to the LGV strain detected in New York City and overseas.?

Pathela suggested that messages for reducing the spread of LGV should be targeted toward the same group of men for whom syphilis prevention activities are already in place. These messages should include: education about LGV and other STDs, safer sex practices, and the need for increased screening for STDs.

?LGV can be a painful infection and may make it easier to get and spread HIV. Therefore, identification and treatment of cases and disease control measures, such as partner notification and post exposure prophylaxis, are of utmost importance,? she said. ?It is also important that health care providers, particularly HIV care providers, be aware of the links between HIV, syphilis and LGV among MSM.?

Diagnostic test developed

LGV is a public health challenge because diagnosis is hindered by symptoms that frequently mimic those of other anorectal problems. There is also a lack of quick and easily administered diagnostic test. Current testing methods require time-consuming genetic sequencing that can take several days to provide results and can only be performed in technologically advanced and equipped laboratories. Prior to 2005, reported LGV cases in New York City were based largely on clinical impressions and did not have specific laboratory confirmation.

?Very few labs have the technology to test anal rectal specimens for LGV and most suspected cases are referred to the CDC,? Douglas said. ?Because this may result in delays in diagnosis, the CDC recommends that health care providers presumptively treat suspected cases for LGV rather than wait for test results.?

However, at the conference, the CDC announced that it has developed a new test to quickly and accurately diagnose the strains of chlamydia that cause LGV.

The new real-time polymerase chain reaction test, developed at the CDC, works by identifying the specific DNA sequences associated with both LGV and non-LGV chlamydia strains, and produces results in just a few hours. Studies to determine the accuracy of the test indicate that CDC researchers were able to correctly identify almost all LGV specimens evaluated. This testing method is still experimental; however, once validated, the CDC plans to offer the test to public health labs on a regional basis.

?Although still in the early stages of development, this new test is a promising step in our efforts to better understand, diagnose, and prevent LGV infection,? said Douglas. ?Ultimately, quicker diagnosis of LGV could help affected communities more effectively combat this disease in conjunction with other STD prevention and treatment efforts for MSM.?

For more information:

Pathela P. Enhanced surveillance for Lymphogranuloma venereum in New York City. Poster 36.

Pathela P. Rapid development of local laboratory capacity for LGV diagnosis: The New York experience. Poster 37.

Liu H. Multiplex real-time PCR assay to differentiate between lymphogranuloma venereum and other genito-urinary chlamydial infections. Poster 33.

All presented at: 2006 National STD Prevention Conference; May 8-11, 2006; Jacksonville, Fl.

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I found it interesting that LGV was co-morbid with HIV in "the majority of cases". Since it is caused by "invasive strains of Chlamydia trachomatis", it makes me wonder.

Does a comprimised immune system make you more likely to get an infection of LGV that would "stick" OR do you catch LGV independently?

A healthy immune system routinely disposes of all sorts of infections that you never know about.

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I had no idea that lymphogranuloma venereum was an STD. In fact if I'm honest I'd never even heard of it.

So thanks to this post I now know, and thanks to the browsing I've just done I also know chlamydia affects men - I'd often wondered, but it's a difficult question to slip into a conversation. Until ten minutes ago I thought it was a 'womans problem' only. :roll:

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There are definitely people who care about this sort of information.

Absolutely! :(

I am very curious if there is a specific age group identified with this STD? Some younger males don't understand the necessity for following a regimen of safe anal sex.

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