bad strain of chlamydia not usually seen in this country
appears to be slowly spreading among gay and bisexual men,
an infection that can increase their chances of
getting or spreading HIV.
chlamydia, this sexually transmitted disease has caused a
worrisome outbreak in Europe, where some countries have
confirmed dozens of cases. Diagnoses confirmed by U.S.
health officials still are low, just 27, since they
warned a year ago that the strain was headed here.
say that's undoubtedly a fraction of the infections,
because this illness is incredibly hard to diagnose: Few
U.S. clinics and laboratories can test for it. Painful
symptoms can be mistaken for other illnesses, such as
irritable bowel syndrome.
And because LGV
chlamydia doesn't always cause noticeable symptoms--right
away, at least--an unknown number of people may silently
harbor and spread it, along with an increased risk of
"My feeling is
that what we're seeing now is still the tip of the
iceberg," says Philippe Chiliade of the Whitman-Walker
Clinic in Washington, D.C., which diagnosed its first
few cases of LGV last month and is beginning to push
for asymptomatic men to be screened.
The Centers for
Disease Control and Prevention already was counting an 8%
increase in HIV among gay and bisexual men between 2003 and
2004, before LGV's arrival was recognized.
"We are really
concerned about this," says Catherine McLean of the
CDC's HIV and STD prevention program.
ability to test for LGV is "what's really critically
important," she adds. "The prevalence of the disease is
probably quite a bit higher than the reported cases
indicate, either here or in Europe, but we don't yet
Three weeks of
the antibiotic doxycycline effectively treats LGV. But
patients have to know they're at risk, then find a test.
by bacteria, is among the most common sexually
transmitted diseases. As many as 3 million Americans a year
may become infected with common strains; it's best
known for causing infertility in women if left
virulent strain is called lymphogranuloma venereum, or LGV.
It's not a new form, but one rarely seen outside of Africa
or Southeast Asia. So STD specialists were stunned in
late 2004 when the Netherlands announced an outbreak
that reached over 100 cases; last summer one clinic
there reported seeing one to two new patients a week. Cases
also have surfaced in much of Western Europe and the
United Kingdrom. As with the U.S. cases, many also are
coinfected with HIV.
from regular chlamydia: swollen lymph nodes in the groin;
genital or rectal ulcers; and painful bowel movements and
other gastrointestinal symptoms that may mimic
inflammatory bowel disease. Such symptoms leave
patients particularly susceptible to HIV infection if they
also encounter that virus.
LGV can infect
both sexes, although new cases diagnosed so far are among
men having sex with men.
requires nucleic acid testing, a complex type of genetic
testing not yet commercially available for rectal use. The
CDC then uses even more sophisticated testing to
confirm the diagnosis.
is difficult, no one knows how prevalent LGV truly is. In
a surprise finding last fall, Dutch scientists tested some
tissue samples stored in San Francisco since the 1980s
and found evidence that today's LGV strain had gone
unrecognized at the time. So has it been simmering
here all along, or is it on the rise?
Regardless of how
that question turns out, LGV is one more sexually
transmitted illness that plays a role in HIV. Thus, the CDC
is encouraging doctors who spot LGV symptoms to
contact their local health department for help in
finding a nearby testing lab or in shipping samples to
CDC for testing there.
"But I don't want
people to think you have to have severe pain,"
cautions Chiliade, whose clinic recently became authorized
to offer the NAT rectal screening--and who recommends
it for gay men who have had unprotected sex even if
they feel no symptoms. (AP)