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LGV a Sexually Acquired Infection

LGV a Sexually Acquired Infection, LGV is a bacterial infection caused by a number of sub-types of the bacterial Chlamydia trachomatis (types L1, L2, L2b and L3). These sub-types can have more serious consequences than the more common types of Chlamydia. They are more invasive and can spread beyond the mucosal lining such as the mouth and rectum, causing inflammation and damage of the tissues.

Until recently, LGV was primarily thought of as a Sexually Acquired Infections found in tropical areas such as Africa, Asia and the Caribbean. There were few cases seen in the UK or elsewhere in Europe & the cases were thought to have been picked-up abroad. However in 2003 a cluster of LGV infections was diagnosed among MSM in the Netherlands. Most of the men diagnosed HIV; large numbers of over-lapping male sexual partners (often via sex parties); and reported unprotected anal intercourse and fisting. Since then more cases have been recorded in Europe. The greatest numbers have been reported in the UK, France, the Netherlands and Germany. Between 2003 and 2008 a total of 849 individuals were diagnosed with LGV in the UK – the largest number of cases in Europe. All but five were MSM. Their average age was 37, 75% also had HIV and 50% had another STI at the time of LGV diagnosis. Cases were seen across the UK but concentrated in London, Brighton and Manchester. The number of cases recorded in 2009 and 2010 was higher than in previous years. However, in comparison to infections such as Gonorrhoea and Chlamydia, the numbers diagnosed with LGV remain low.

What are the symptoms of LGV?

Symptoms can be complex and severe, causing inflammation, lymph node infection, fever, muscular pain and general ill-health. Symptoms can develop on different parts of the body, such as the genitals, the anus, rectum, oral cavity and lymph nodes.

There are three stages of infection and symptoms vary depending on which part of the body is infected. Some people with LGV may not experience any symptoms but they can still pass the infection to their sexual partners.

Stage one: A small painless blister or sore appears where the infection first entered the body: this may go unnoticed. If stage one occurs inside the anus then it may cause rectal inflammation or proctitis (an inflammation of the anus and the lining of the rectum). This is the commonest symptom of LGV in MSM. The painful inflammation may result in ulceration, discharge, bleeding, constipation, and a feeling of needing to defecate. Fever and lower abdominal pains may develop.

Stage two: Occurs two to six weeks later, usually after the appearance of an LGV ulcer somewhere. Inflamed and swollen lymph glands may then appear near the groin, armpit or neck. If untreated, these glands can swell to large abscesses full of pus which then burst through the skin.

Stage three: This may occur months or years later if LGV is not diagnosed and treated.

Chronic symptoms can become scarring, causing permanent damage to the affected area. Untreated rectal infection leads to rectal structure which may require surgery. T he penis and sac that contains the testicles can swell massively with fluid. Spread of the bacteria throughout the body can occasionally lead to arthritis or inflammation of the lungs.

How is LGV passed on?

LGV is almost exclusively acquired sexually, with unprotected anal intercourse and fisting being the two activities that are most commonly implicated. Many men with LGV report group sex, often using sex-on premises venues (saunas, back rooms, sex clubs) or attending sex parties. The latter may be organised specifically for men with diagnosed HIV to have unprotected anal intercourse together. This happens as the bacterium enters a moist mucosal surface. In MSM this is most commonly the rectum, but infections via the penis or mouth also occur. If a man has the infection in his penis and has insertive unprotected anal intercourse, he can pass LGV on to his partner. But the majority of men with LGV are infected in their rectum and penile LGV infection is rare. This suggests that among MSM the bacteria may cross from one rectum to another.

It has been suggested that, if man 1 has insertive anal intercourse with man 2, and then goes on to have insertive anal intercourse with man 3, LGV could be passed from man 2 to man 3. The transmitter of LGV does not have the infection himself, but his penis could transfer the bacteria from one man to another. This could also happen if he used a condom, but used the same condom for both partners. LGV can probably be passed in a similar way during fisting or fingering, even if a fisting glove is used, but not changed between partners. Transmission can also happen if enemas or douching equipment are shared without proper cleaning between partners. Therefore, risky practices are anal intercourse, fisting, and sharing dildos or other sex toys without taking adequate precautions to prevent transmission. These precautions include using condoms and gloves, changing condoms and gloves between users, not sharing lubricant and agreeing safety rules prior to sex (particularly if recreational drugs are utilised.

How can LGV transmission be prevented?

There is no vaccine against LGV and previous infection does not provide immunity in the future. Many cases probably originate in men who have no symptoms and are unaware that they have LGV. Condom use for anal intercourse, and latex gloves for fisting offer a large degree of protection as long as a new condom or glove is used with each man in any situation where multiple sex partners are met. Similarly sex toys like dildos should be covered with a fresh condom for each new partner. Alternatively the toys should be cleaned with warm water and anti-bacterial soap before being used again. Sharing enema or douching equipment also risks LGV transmission. Regular sexual health check-ups, including Chlamydia testing, will help identify LGV infections. Anyone with LGV-type symptoms or who finds out that they have had sex with someone with LGV should get a check-up as soon as possible at the GU clinic.

Please call 21227981. It is recommended that people taking treatment for LGV should avoid sexual contact until treatment has been completed and they have been given the all-clear.

Urine or swab tests for chlamydia will also detect LGV infection, so a negative chlamydia test usually means no LGV infection. If a person is positive for chlamydia and either has LGV-type, treatment is needed.

How is LGV treated?

Most cases of LGV (especially if treatment is begun during the first or second stage) can be successfully treated using the antibiotic Deoxycycline, without any lasting damage. Deoxycycline is also used to treat other sexually acquired infections. For example, a seven day course is the standard treatment for the more usual strains of Chlamydia. Because LGV is more invasive, a longer course of 21 days is necessary. In severe cases, the late complications of LGV infection may need surgical repair.

We have had 1 case of LGV in 2014 documented in Malta; however this is definitely not a true reflection of the local situation. This is why it is very important that, our local community is informed about such an emerging Sexually Acquired Infection as it can be easily prevented. In addition, one can get oneself tested easily and if such an infection is found, it can be treated.

Therefore STAY SAFE! Always USE CONDOMS *correctly!

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