The city health department is warning New Yorkers that two cases of a rare form of chlamydia called lymphogranuloma venereum (LGV) have been diagnosed in residents here.
“We are notifying New Yorkers that we have identified two cases of a new form of a sexually transmitted disease that is affecting gay men in New York City,” said Dr. Thomas R. Frieden, commissioner of the city’s Department of Health and Mental Hygiene.
LGV, which can be disfiguring, is a strain of chlamydia, a common sexually transmitted disease, that can infect the groin and colon. Symptoms can include swollen lymph glands and groin ulcers. A colon infection can lead to blood or pus in the feces and to constipation. The bug can be easily treated, if recognized in time, with a three-week course of antibiotics, but diagnosis
In October, the federal Centers for Disease Control and Prevention (CDC) issued an alert about LGV to state and local health departments noting that “recent reports from Belgium, France and Sweden confirm that LGV is occurring elsewhere in Europe” and advised health officials to be “vigilant for LGV.”
Last fall, health authorities in the Netherlands reported that they had seen 92 cases among gay men during the 17 months prior to September 2004. The San Francisco health department reported three cases among gay men in that city last summer. One case was reported in Atlanta last year.
While New York City typically sees about ten LGV cases each year, the current two are the first in the city that may be tied to a larger sexual network where the bacteria is spreading. The two new cases in the city are the same strain as the bug found in the Netherlands. The potential for further spread of LGV prompted the health department to act.
“We are encouraging doctors to have a low threshold for treatment in patients with suspected LGV and to contact us so that we can assist with getting diagnostic tests done, which are not easy, they’re complex, and with managing the situation so that we can stop the spread of LGV in New York City,” Frieden said at a February 2 press conference.
Frieden was joined by community leaders who praised the health department for its response, told gay men to be vigilant for the bug and urged them to practice safe sex.
“We are very, very gratified that the commissioner is taking a proactive step in this issue,” said Tokes M. Osubu, executive director of Gay Men of African Descent. “We are so happy that we are not waiting ten years before we are addressing this issue.”
Jay Laudato, executive director of the Callen-Lorde Community Health Center, said that men need to be honest with healthcare providers about their sex lives.
“This does not present as a classic sexually transmitted disease,” Laudato said. “If you are not going to be forthcoming about your risk behaviors with your doctor, you are not going to be giving that person the right information to be able to diagnose this.”
Ana Oliveira, executive director of the Gay Men’s Health Crisis (GMHC), said that quick detection and intervention were essential to stopping LGV.
“It is very important that they intervene at an early stage,” she said.
Dennis deLeon, president of the Latino Commission on AIDS, said that gay men must practice safe sex.
“It sounds like a tired message, practice safer sex,” he said. “Don’t put anything up your behind that doesn’t have latex around it.”
DeLeon also urged gay men to press their doctors to aggressively test for the bacteria.
“This is a disease that can leave permanent scarring in the anus and, I think, merits special attention,” he said. “Gay men who are HIV-negative, gay men who are HIV-positive, should be asking their doctor about chlamydia… Many doctors have grown lazy about the questions they ask their clients. This is the kind of disease that requires additional testing.”
While LGV is serious, Frieden did not say that the bug is fatal if untreated.
“This can be a disfiguring illness,” Frieden said. “It can require surgical correction and leave permanent scarring… The complications of it can be very serious… With treatment, response is generally good.”
Diagnosing LGV can also be difficult and the health department is telling doctors to not wait for test results, but to treat “presumptively.”
The testing is done in only certain labs.
“The laboratory testing for this is not well developed so it requires specialized laboratories,” Frieden said. “That’s why we encourage doctors who suspect their patients to contact us and we will arrange to have the specimens provided to the laboratories that will do the definitive testing.”
It can take up to six months before the symptoms of LGV appear and an infected person may be able to infect others during that time.
The health department could not say where or how the New York City cases were infected. It is possible that there have been other cases in the city that doctors thought were simple infections. Those cases could still have been treated successfully even without proper dia
“There have undoubtedly been others that have not been confirmed,” Frieden said. “It is generally the case with sexually transmitted diseases that there are more diagnosed than are reported. The exact extent of the problem is still under investigation.”