Eurosurveillance, Volume
10, Issue
28,
14 July 2005
First confirmed case of lymphogranuloma venereum (LGV) in Switzerland
Nadia Liassine1 (nliassine@unilabs.ch),
Aileen Caulfield2, Gaelle Ory3, Alexandre Restellini3,
Bertille de Barbeyrac4, Radan Sitavanc1, Marie-Christine
Descombes1 and Dieter Luescher5
1Bioanalytique-Riotton, Unilabs group, Geneva,
Switzerland
2Centre Médical du Léman, Geneva, Switzerland
3Groupe Médical d’Onex, Geneva, Switzerland
4Centre National de Référence des Chlamydia, Université
de Bordeaux 2, France
5Diagnostica, Unilabs group, Zürich, Switzerland
In April 2005, a 31 year old man in Geneva presented with
anorectal syndrome (rectal pain and bloody stools) and diarrhoea which had
been occurring at least 3-4 times per day for 2 weeks. He reported having
unprotected anal intercourse with a man in Berlin approximately 6 weeks prior
to symptom onset. Endoscopic examination of the colon revealed inflammation
of the distal third of the rectum with areas of small superficial erosions
and one large erosion covered with fibrin.
Microbiological analysis of a rectal biopsy using polymerase chain reaction
(PCR) showed the presence of Chlamydia trachomatis. A molecular
technique confirmed the case as L2 genotype [1]. High titres of C. trachomatis
IgG (1280) and IgA (160) were observed using immunofluorescence assay. Tests
for syphilis, HIV, and gonorrhea were all negative. The patient was treated
with doxycyline 100mg twice daily for three weeks. After this, symptoms
were had decreased but not resolved, and so he was given a second antibiotic
treatment of erythromycin 500mg four times daily for three weeks. The patient
improved after this treatment. Proctoscopic examination was repeated 3 weeks
after the end of treatment and showed normal macroscopic rectal mucosa.
Repeat PCR in a rectal specimen also showed the absence of C. trachomatis
at this stage.
This is the first confirmed case of lymphogranuloma venereum (LGV) in Switzerland
[2]. Two previously suspected cases (PCR of C. trachomatis positive
in rectal specimens) were diagnosed in Geneva in February and April 2004.
The lack of diagnostic facilities in Switzerland prevented an adequate diagnosis.
Recently, an increase of sexually transmitted infections (STI), particularly
syphilis and Neisseria gonorrhoeae infections, has been reported
in Switzerland, especially in Geneva and Zürich [3]. LGV’s emergence
in Switzerland following the reports of LGV in men who have sex with men
(MSM) in different European cities is not surprising. LGV is probably underdiagnosed
in Switzerland at present.
Outbreaks of LGV in MSM have been reported since 2004 in Europe [4,5] and
the United States and Canada [6,7]. It is crucial to inform medical workers
and high risk populations of this new STI so that patients can be treated
rapidly and appropriately, and dissemination of the disease avoided [12].
Enhanced surveillance programmes are now being implemented in France, the
United Kingdom and the Netherlands [1,5,8]. Diagnostic tests specific for
LGV are urgently needed.
References:
- Herida M, Sednaoui P, Couturier E, Neau D, Clerc M, Scieux C, et al. Rectal
lymphogranuloma venereum, France [letter]. Emerg Infect Dis 2005; 11(3)505-6.
(http://www.cdc.gov/ncidod/EID/vol11no03/04-0621.htm)
- Premier cas de lymphogranulomatose vénérienne dans le canton
de Genève. Bulletin BAG 2005;(25):432-3. (http://www.bag.admin.ch/dienste/publika/bulletin/f/BU25_05f.pdf)
- Lautenschlager S. Sexually transmitted infections in Switzerland : return
of the classics. Dermatology 2005; 210: 134-42.
- Götz H, Nieuwenhuis R, Ossewaarde T, Bing Thio H, van der Meijden
M, Dees J, et al. Preliminary report of an outbreak of lymphogranuloma venereum
in homosexual men in the Netherlands, with implications for other countries
in western Europe. Eurosurveillance Weekly 2004; 8(4):
22/01/2004 (http://www.eurosurveillance.org/ew/2004/040122.asp#1)
- Van de Laar MJ, Fenton KA, Ison C. Update on the European lymphogranuloma
venereum epidemic among men who have sex with men. Eurosurveillance
Weekly 2005; 10(22): 02/06/2005. (http://www.eurosurveillance.org/ew/2005/050602.asp)
- PRO/EDR> Lymphogranuloma venereum - USA (New York City). in: ProMED-mail
[online]. Boston US: International Society for Infectious Diseases, archive
number 20050203.0369, 3 February 2005. (http://www.promedmail.org)
- Kropp RY, Wong T; Canadian LGV Working Group. Emergence of lymphogranuloma
venereum in Canada. CMAJ 2005; 172(13) :1674-6.
Epub 2005 May 31. (http://www.cmaj.ca/cgi/content/full/172/13/1674)
- French P, Ison CA, Macdonald N. Lymphogranuloma venereum in the United
Kingdom. Sex Transm Infect 2005; 81(2):97-8.
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