The STD Control Branch of the California Department of Health Services issued a written warning to all public health officials in the state on Dec. 20 concerning a small outbreak in San Francisco of a rare form of chlamydia called lypmphogranuloma venereum, or LGV.

Symptoms include gastrointestinal bleeding, inflammation of the rectum and colon, genital ulcers, swollen lymph glands and flu-like symptoms. Other symptoms may include an itching anus, blood or mucus in the stool, or straining and cramping during bowel movements.

The San Francisco Department of Public Health said this particular strain infects the lymphatic system and, if left untreated, can cause even more severe complications which include scarring of the genitals and colon, as well as the potential swelling and bursting of lymph glands near the groin.

The San Francisco Department of Public Health’s STD branch on Dec. 22 documented nine men who have sex with men (MSM) infected with LGV. These are the first cases of LGV in San Francisco since 2001.

Public health officials were notified of LGV in October when the U.S. Centers for Disease Control and Prevention (CDC) reported the Netherlands had documented 92 LGV cases among MSM for a 17-month period ending in September. The country usually sees fewer than five cases per year. According to the San Francisco Department of Public Health, other cases have been reported in Belgium, France, Sweden, the U.K. and Atlanta, Ga.

CDC data stated LGV rarely occurs in the U.S. and other industrialized countries, and is most common in Africa, Southeast Asia, Central and South America and Caribbean countries.

Terry Cunningham, chief of the Office of AIDS Coordination for the county of San Diego said there have been no reported cases here in San Diego, but that doesn’t mean it could not surface.

“Today we have not seen any cases in San Diego County. It has shown up in several other areas of the country and there’s no reason to think that it won’t show up here at some point in time, especially since we are a travel and vacation destination for a lot of people,” Cunningham said.

The CDC has recommended taking 100 mg of the antibiotic doxycycline twice a day for a period of 21 days to treat confirmed cases of LGV or any cases of rectal chlamydia.

CDC officials worry LGV can easily be misdiagnosed since it is not common in industrialized nations like the U.S.

Cunningham believes it is important to abide by these recommended treatment guidelines set by the CDC and take the necessary precautions if a person exhibits any symptoms similar to LGV.

“It is treatable. The problem is that people mistake it for other diseases and until it gets fairly virulent … we need to make sure people who have symptomology are correctly diagnosed and diagnosed early.”

Dutch authorities found many of the men recently infected with LGV in the Netherlands had participated in sex parties and unprotected anal sex – many also were infected with HIV.

Gail Bolan, chief of the STD Control Branch of the California Department of Health Services, noted in a written statement that LGV increases risk of HIV transmission.

Dr. Robert Gunn, STD control officer in the Division of STD and Hepatitis Prevention Services branch of the County of San Diego Health and Human Services Agency, explained why those who are infected with HIV make the transmission of LGV easier and vice versa.

“In any case where there’s an ulceration, if you’re HIV infected, it brings more HIV to the surface so to speak. It gives it a portal of exit because a lot of white blood cells carry HIV in the fluids that seep out of these lesions,” said Gunn.

“Any ulcer of STD — syphilis, herpes, LGV, or chancroid — all increase HIV transmission both directions,” Gunn added.

Gunn cautioned it is extremely important to take action and get treatment for LGV if it does occur in San Diego.

“We don’t want to miss the infection. Of course if we do see it here in San Diego then we have to really increase our vigilance and our information transfer to our practitioners and clinicians about it,” Gunn said.

Any clinician suspecting a possible LGV case marked by rectal bleeding and proctitis should call the County of San Diego’s STD Clinic at (619) 692-8550 for information about proper testing procedure or contact the STD Control Branch of the California Department of Health Services at (510) 286-6600.

Cunningham warned this outbreak is just another reason to continue safe-sex practices. “The same precautions should be taken that all gay men should be taking all the time – no unprotected anal intercourse…” l