Homoseksuele mannen

Until 2003, Lymphogranuloma venereum (LGV), an aggressive form of chlamydia, was considered to be a rare tropical disease, endemic to Africa, Asia and the Caribbean. Then, an outbreak of LGV in the Netherlands signaled the start of an epidemic amongst men who have sex with men (MSM). A decade later, a new study suggests that regional differences in testing rates underestimate the actual incidence of LGV across the country.

Lymphogranuloma venereum (LGV)

LGV is a sexually transmitted infection caused by the bacterium Chlamydia trachomatis and symptoms include genital ulcers, abscesses and proctitis (inflammation of the anus and rectum). Although the number of cases in the Netherlands has fluctuated since LGV was first reported in 2003, the incidence has been consistently higher than before 2003 and increased sharply in the first half of 2012. In an effort to understand how this epidemic developed, the team looked at data on MSM attending STI (Sexually Transmitted Infection) Clinics in the Netherlands between 2006 to June 2012.

Regional differences in LGV testing rates

The team found that of the 6,343 cases of anal chlamydia diagnosed in that period, only 4,776 were further tested for LGV and importantly, the rate of testing for LGV varied enormously between the eight regions, from 7% to 97%. The team was surprised by these results. “We expected a difference, partly because of the cost of LGV testing, but the difference was much greater than we expected and it tells us that some clinics almost never test for LGV.”

Risk groups

This study also shows since the first outbreak in 2003, LGV infection has largely been limited to the MSM population, and that infection is significantly more prevalent in MSM who are HIV positive and older than 40. Nevertheless, the team suggests that expansion of the infection to the general population could also be an important risk, pointing to recent reports of LGV infection in heterosexual women. It is therefore important that health professionals continue to be vigilant against LGV infection also in heterosexuals whilst strengthening and harmonising LGV testing in MSM who have anorectal chlamydia.