A rare strain of chlamydia called Lymphogranuloma venereum
(LGV) has landed in Canada and STI experts say doctors
must get the message out to their patients — especially
gay men — to prevent its spread.
"Doctors should be vigilant about
asking their patients about sexual practices," says
Dr Tom Wong, director of the Community Acquired Infections
Division at the Public Health Agency of Canada and part
of the Canadian LGV working group. "If affected groups
of individuals continue their unsafe sex practices and
do not seek early diagnosis and treatment, I can certainly
see the potential for an increase in the occurrence
of LGV in Canada."
LGV is caused by the bacteria Chlamydia
trachomatis. But unlike the commoner genital chlamydia,
which is easily treatable with one dose of antibiotics,
LGV causes more persistent infections and requires three
weeks of antibiotic treatment.
Symptoms appear anywhere from three
to 30 days after infection and include the appearance
of small painless sores around the area where the bacteria
entered the body (usually the genitals, rectum or mouth).
Later symptoms include low fever, chills, fatigue, joint
and muscle ache and swelling and drainage of lymph nodes
in the affected area. If left untreated, LGV can cause
scarring and tissue destruction.
UNKNOWN
QUANTITY
One of the biggest problems with LGV is that it's easily
misdiagnosed.
"LGV is not a disease that's very
known, so treating and recognizing it is not easy,"
notes Dr Marc Steben of the Institut Nationale de Santé
Publique du Québec.
"It needs to be added to the list
of sexually transmitted infections that are a threat
in Canada," adds Dr Barbara Romanowski of the Department
of Infectious Diseases at the University of Alberta.
One of the reasons Canadian docs
may not be up to speed on LGV is that, until recently,
cases were almost exclusively confined to Africa, Asia
and South America. Then, between 2003 and 2004, 92 cases
cropped up in the Netherlands; LGV then surfaced in
other Western countries, including Canada. Those infected
were almost exclusively men who'd had sex with men,
many of whom hadn't recently travelled to regions traditionally
associated with the disease. Most Canadian cases so
far have been in big cities in Quebec and Ontario. Between
January 2004 and November 2005, 38 cases had been reported
to the public health agency of Canada (23 confirmed
and 15 probable). Worryingly, there's a high concurrent
rate of HIV, hepatitis B and C and other STIs among
those infected.
All the experts agree that the
spread of LGV is a sign of a general decline in safe-sex
practices among Canadians in the last few years. "People
have condom fatigue," says Dr Romanowski. "I think we've
dropped the ball in not continuing with safe-sex messages."
While there was a slight decline
in the number of reported LGV cases in the last year,
Dr Steben says that doesn't mean it's no longer a concern.
"If we're not careful it's going to come back," he warns.
For advice on testing or specimen
collection, contact your local lab or the National Microbiology
Laboratory at 204-789-2000.
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