July 5, 2006

Lymphogranuloma Venereum (LGV) Epi Update

As of July 5, 2006 there have been 69 cases of lymphogranuloma venereum (LGV) reported to the Public Health Agency of Canada (PHAC); 35 are confirmed cases and 34 are probable cases according to the national case definition.

The earliest report of symptom onset is in November 2001, with the next earliest case reporting symptoms beginning in September 2003; the most recent case appears to have had symptoms that started in April 2006 (Figure 1). The most common presenting symptoms reported are anorectal symptoms (proctitis, bloody stools) and inguinal or ‘groin’ lymphadenopathy (swelling). All reported cases to date have been male, mostly between the ages of 30 and 45; the majority have been identified as Caucasian, where information on ethnic origin was available. Most of the cases have reported recent sex, often unprotected, with (a) male partner(s) which occurred primarily in bathhouses, though sex in a private residence and internet partnering have also been commonly reported. Fisting and rectal use of crystal methamphetamines have also been reported by a small number of cases. All but two cases appear to be unlinked to travel to endemic regions or areas reporting LGV outbreaks outside Canada.

Concurrent infection with HIV, other STIs, and hepatitis C has been common among the cases reported. 28 out of 36 (77.8%) LGV cases were infected with HIV and 9 out of 40 (22.5%) cases were co-infected with syphilis; all of the LGV cases who were positive for hepatitis C (4 cases) were HIV positive as well. As with other STIs, having LGV can increase the risk of acquiring or transmitting HIV, other STIs, and bloodborne pathogens such as hepatitis B and C.

Figure 1- Epidemic curve of 54 cases of LGV in Canada reported to the Public Health Agency of Canada for which the date of symptom onset was known.

* No cases with date of symptom onset between September 2003 and January 2004