Important note: Information in this article was accurate in 2004. The state of the art may have changed since the publication date.
San Francisco Chronicle - December 21, 2004
Sabin Russell, srussell@sfchronicle.com.
Known as lymphogranuloma venereum, or LGV, the disease is a form of the common sexually transmitted infection chlamydia -- but this particular strain can cause scarring of the genitals and colon, and can produce a swelling and bursting of lymph glands near the groin.
Although the disease is seldom seen outside of poor, tropical nations, doctors in Rotterdam reported 92 cases among gay men during a 17-month period ending in September. Isolated cases have also been reported in Belgium, France, Sweden and Atlanta, Ga.
In November, doctors at San Francisco's City Clinic treated one man with the disease, and subsequent tests of stored specimens spotted three other cases that occurred this summer but had gone undetected by conventional screens.
None of the four patients who were found to have the bug in San Francisco had visited the Netherlands, an indication there may be other cases yet to be discovered in the city, said Dr. Sam Mitchell, a Department of Public Health epidemiologist.
The four cases in San Francisco were among gay men, some of whom also tested positive for HIV, the virus that causes AIDS. Mitchell said there is no indication that HIV-positive patients are at higher risk for complications of LGV, but there is concern that a patient with the chlamydia infection might be more prone to contract HIV because of the ulceration caused by the bacteria.
As unpleasant as this form of chlamydia may be, it is easily treatable if caught in time. "The idea is to knock it out quickly. If it circulates widely, it could be quite challenging," Mitchell said.
Treating LGV successfully requires a three-week course of antibiotics, instead of the single dose of medicine used to treat common strains of chlamydia. Because it is difficult to distinguish early infections of LGV from the more benign microbes, Mitchell said the city is recommending that doctors treat all cases of rectal chlamydia with the three-week regimen.
"We think doctors should err on the side of caution," he said.
City epidemiologists found the three additional cases by screening samples taken from more than 100 patients treated for rectal chlamydia in the past year.
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