Health Alert

[Guest Mikel]

What does anyone know about how LGV is spread? (Lymphogrunuloma venereum). Apparently the CDC has warned that the disease is poised to surface among gay and bisexual men in the US as it has already surfaced in Europe. I understand that it can be treated with a 3 week course of antibiotics ...if diagnosed. Is it spread ONLY through unprotected anal intercourse or can it be spread through oral sex??

 

I think the word should get out...an "informed" word that is.

[Guest Mikel]

Let's see if I can set up this link to CNN.com/HEALTH...?

 

http://www.cnn.com/2004/HEALTH/10/29/sex.infection.reut/index.html

[Guest Mikel]

Hooboy:

 

Let's see if you can't keep this "Health Alert" bumped up to the top until the word gets out. Cou;d be important.

[+ Lucky]

As of October 16th, it is reported that this is an uncommon disease on the decline in the United States snce 1972. Hop on it, Hooboy!

 

Lymphogranuloma Venereum (LGV)

Last Updated: October 16, 2004 Rate this Article

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Synonyms and related keywords: LVG, sexually transmitted disease, STD, sexually transmitted infection, STI, Chlamydia trachomatis, C trachomatis, venereal disease, VD, HIV, AIDS, herpes simplex virus, HSV, syphilis, inguinal lymphadenopathy, genital papule, genital pustule, proctocolitis, genital ulcer disease, rectal stenosis, perirectal fissures, lymphorrhoids, elephantiasis, rectal adenocarcinoma, genitoanorectal syndrome, bubo, buboes, esthiomene, saxophone penis

 

AUTHOR INFORMATION Section 1 of 10

Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Bibliography

 

 

 

 

Author: Gregory Shipkey, MD, Staff Physician, Department of Emergency Medicine, William Beaumont Army Medical Center

Coauthor(s): Alexandre F Migala, DO, FAAEM, Aerospace Medicine Service, Assistant Clinical Professor, Department of Family Care Medicine, Darnall Army Community Hospital; Gary P Holmes, MD, Division of Infectious Disease, Associate Professor, Departments of Epidemiology/Biostatistics and Medicine, Texas A&M University Schools of Rural Public Health and Medicine

 

 

Gregory Shipkey, MD, is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and American Medical Association

 

Background: Lymphogranuloma venereum (LGV) is an uncommon sexually transmitted disease (STD) caused by Chlamydia trachomatis. This condition is characterized by extremely painful inguinal lymphadenopathy.

 

 

Pathophysiology: C trachomatis is an obligate intracellular bacterium. Of the 15 known clinical serotypes, only the L1, L2, and L3 serotypes cause LGV. These serotypes are more virulent and invasive compared to other chlamydial serotypes. Infection occurs after direct contact with the skin or mucous membranes of an infected partner. The organism does not penetrate intact skin. The organism then travels by lymphatics to regional lymph nodes, where they replicate within macrophages and elicit systemic disease. While transmission is predominantly sexual, cases of transmission through laboratory accidents, fomites, and nonsexual contact have been reported.

 

LGV occurs in 3 stages. The first stage, which is often unrecognized, consists of a rapidly healing, painless genital papule or pustule. The second stage, consisting of painful inguinal lymphadenopathy, occurs 2-6 weeks after the primary lesion. The third stage, which is more common in women, may occur many years after the original infection and is characterized by proctocolitis.

 

 

Frequency:

 

 

In the US: Rates of LGV have steadily declined since 1972, with 113 known cases reported in 1997.

Internationally: LGV is an uncommon disease, although it may account for 2-10% of patients with genital ulcer disease in selected areas of India and Africa. The disease is most commonly found in areas of the Caribbean, Central America, Southeast Asia, and Africa.

Mortality/Morbidity:

 

With appropriate treatment, the disease is easily eradicated. Death is a rare complication but could possibly result from a small bowel obstruction or perforation secondary to rectal scarring.

Morbidity is common, especially during the third stage of the disease, and includes such conditions as proctocolitis, perirectal fissures, abscesses, strictures, and rectal stenosis. A chronic inflammatory response may lead to hyperplasia of the intestinal and perirectal lymphatics, causing lymphorrhoids, which are similar to hemorrhoids. Strictures and fistulous tracts may lead to chronic lymphatic obstruction, resulting in elephantiasis, thickening or fibrosis of the labia, and edema or gross distortion of the penis and scrotum. Reports show an association between adenocarcinoma (primarily rectal adenocarcinoma) and chronic untreated LGV.

Sex: LGV is an STD and probably affects both sexes equally, although it is more commonly reported in men. This predilection may be because early manifestations of LGV are more apparent in men and are thus diagnosed more readily. Men typically present with the acute form of the disease, whereas women often present later, after developing complications from late disease.

 

Age: LGV may affect any age but has a peak incidence in the sexually active population aged 15-40 years. CLINICAL Section 3 of 10

Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Bibliography

 

 

 

 

History: The clinical course of LGV consists of the following stages:

 

First stage (primary LGV)

This stage occurs 3-30 days after inoculation.

 

Primary LGV begins as a small, painless papule or pustule that may erode to form a small, asymptomatic herpetiform ulcer that usually heals rapidly without scarring.

 

The most common sites of infection for men include the coronal sulcus, prepuce, glans, and scrotum. Rarely, symptoms of urethritis occur.

 

The most common sites of infection in women include the posterior vaginal wall, posterior cervix, fourchette, and vulva.

 

The initial lesion, especially in women, often goes unnoticed by the patient.

Second stage (secondary LGV)

Secondary LGV begins 2-6 weeks after the primary lesion.

This second stage consists of painful regional lymphadenopathy (usually in the inguinal and/or femoral lymph nodes).

Painful, swollen lymph nodes coalesce to form buboes, which may rupture in as many as one third of patients. Those that do not rupture harden, then slowly resolve.

Inguinal lymphadenopathy occurs in only 20-30% of females with LGV; they more typically have involvement of the deep iliac or perirectal nodes and may only present with nonspecific back and/or abdominal pain.

This stage is when most men present and are diagnosed; most women are not diagnosed in this stage because of their lack of inguinal lymphadenopathy.

 

Constitutional symptoms associated with the second stage include fever, chills, myalgias, and malaise.

 

Systemic spread may lead to the following conditions:

 

Arthritis

 

Ocular inflammatory disease

 

Cardiac involvement

 

Pulmonary involvement

 

Aseptic meningitis

 

Hepatitis or perihepatitis

Third stage (tertiary LGV)

Tertiary LGV is termed genitoanorectal syndrome.

This condition is more common in women, secondary to their lack of symptoms during the first two stages.

Rectal involvement is more common in men who have sex with men and in women who practice anal-receptive intercourse.

Tertiary LGV is characterized by proctocolitis.

Symptoms include the following conditions:

 

Malaise

 

Weight loss

 

Bloody purulent discharge

 

Fever

 

Rectal pain

 

Tenesmus

Physical: Large fluctuant buboes or any otherwise unexplained perianal deformity in a young female should suggest a diagnosis of LGV.

 

First stage (primary LGV)

 

The initial lesion is usually a small, unnoticed painless papule, shallow ulcer, or herpetiform lesion in the genital area.

 

Initial lesions may be differentiated from the more common herpetic lesions by the lack of pain associated with the lesion. Differentiation from a syphilitic chancre is more problematic and requires serologic testing.

Second stage (secondary LGV)

Secondary LGV is characterized by painful lymph nodes (usually unilateral) known as buboes.

 

Enlargement of the inguinal nodes above and the femoral nodes below the inguinal ligament leads to the classic groove sign, which is observed in one third of affected men.

 

Inguinal lymphadenopathy results from a primary lesion of the anterior vulva, penis, or urethra.

 

Perirectal or pelvic lymphadenopathy results from a primary lesion involving the posterior vulva, vagina, or anus.

 

Affected nodes often coalesce and form abscesses, which can rupture and form sinus tracts.

Third stage (tertiary LGV)

Tertiary LGV most often manifests in women.

Patients initially develop proctocolitis.

Patients may present with perirectal fistulas, abscesses, strictures, and rectal stenosis.

Hyperplasia of intestinal and perirectal lymphatics may form lymphorrhoids, which are similar to hemorrhoids.

Patients may develop strictures and fistulous tracts secondary to repeated tissue scarring and repair.

Enlargement, thickening, and fibrosis of the labia may occur in women, a condition termed esthiomene.

Chronic lymphatic obstruction may lead to elephantiasis of the genitals.

Penile and scrotal edema and distortion have been termed saxophone penis.

Causes: The L1, L2, and L3 serovars of C trachomatis cause LGV. Risk factors include residing in or visiting endemic areas, practicing anal-receptive intercourse, eschewing condoms, and working in the commercial sex trade.

[Guest Mikel]

Wow!

 

Thanks, Lucky...

[HooBoy]

Hop on it Hooboy???

 

Do you guys read anything more on this site than this message center?

[LovesYng]

>Hop on it Hooboy???

>

>Do you guys read anything more on this site than this message

>center?

>

 

No not really, nuttin else better to do :9

 

When in doubt I whip it out :+

[VaHawk]

>Hop on it Hooboy???

>

>Do you guys read anything more on this site than this message

>center?

 

I only have time before work each morning, to visit one site. That choice for me is your site, and the first thing I read is your daily gossip posting. I read it first, as most mornings that is the only thing that I have time to read, so I guess, for me, that is the most important daily posting. That is where I saw this alert for the first and so far, only time. Thanks for the heads up, HB, as you are always on top of the latest news.

[+ Lucky]

What heresy! Of course not, Hoo.

[Guest Mikel]

Thanks, HooBoy.

 

Just look at the number of hits for this post. Then realize that each of those people told others who told others...

 

You provide a great service.

 

And thanks for bumping it on top.

[Muscle Lover]

Good current topic

[HooBoy]

Hi Mikel,

 

My purpose was not to bump the thread on top, although that does not hurt on this issue... My post was to let you guys know there is more content on this site than just what you read here.

 

In the Newest Reviews Index, click on the EBriefs link.

 

Beginning Sunday, October 31, we will debut a new series, 15 Minutes , which I hope you find entertaining.

 

And thank you for your participation.

 

HooBoy

[Bearman]

CDC: Rare infection may surface in U.S.

Rare STD spreading in gay, bisexual men in Europe

 

 

 

ATLANTA, Georgia (Reuters) -- A rare sexually transmitted disease that is spreading among gay and bisexual men in Europe could be poised to surface in the United States, the U.S. Centers for Disease Control and Prevention said Thursday.

 

The CDC urged doctors and clinics across the nation to be prepared to diagnose and treat gay and bisexual men infected with Lymphogranuloma venereum (LGV).

 

It issued the advice after receiving reports of recent outbreaks in the Netherlands. The northern European nation has uncovered 92 cases of LGV dating back to 2003. It typically sees fewer than five cases per year.

 

Although LGV can be cured by a three-week course of antibiotics, U.S. health officials could be hard pressed to keep a lid on the spread of the infection because it is uncommon in industrialized nations and easily misdiagnosed.

 

Efforts to combat the disease also are complicated by the tendency of some gay and bisexual men to engage in high-risk sexual behavior.

 

The infection is caused by specific strains of chlamydia, a sexually transmitted disease, and usually marked by genital ulcers, swollen lymph glands and flu-like symptoms.

 

However most of the men recently infected in the Netherlands developed gastrointestinal bleeding, inflammation of the rectum and colon and other problems not often associated with the infection or other sexually transmitted diseases.

 

Belgium, France, Sweden and Britain also have reported infections. It is not known whether America is seeing a similar surge because U.S. doctors are not required to report the infections to local health departments.

 

"We expect it's a question of time before we see cases appearing here," said Dr. Stuart Berman, chief of the epidemiology and surveillance branch in the CDC's division of STD prevention. "This is an early warning."

 

Dutch authorities found that a large number of the men recently infected with LGV had participated in sex parties and unprotected anal intercourse in the year before getting sick. Many also were infected with HIV, the virus that causes AIDS.

 

 

 

--------------------------------------------------------------------------------

 

Copyright 2004 Reuters. All rights reserved.

[Luv2play]

Well, another STD to worry about. It seems from a quick reading of the above that men are more likely to experience the symptoms earlier and more dramatically than women do, with painful swelling of the lymph nodes in the groin area. This obviously would be out of the usual and would send most men scurrying to their doctors. The other pertinent info is that three weeks of a prescribed antibiotic would resolve the problem. Also this seems to be a relatively rare problem, but of course, this could change as we all know, as sometimes small problems become big ones if ignored. A useful posting! Thanks for the info.

[flguy]

Thanks Hoo, Saw it on E-Briefs the other day and sent out to about 20 of my friends. No one seemed to know about it, but they do now. Thanks again.

[trilingual]

Hopefully this infection stays rare in the U.S., but it's a reminder that it's always a good idea to use a physician who is accustomed to treating gay men (they're much more likely to be current on the latest exotic disease rearing its ugly head in the community) and to TELL your doctor that you're a sexually active gay man. Your doctor can't help you if he doesn't understand your situation, who you are, and what kinds of risks you may be exposed to.