We at GMJ are sort of happy to introduce you to this relatively unknown sexually transmitted disease. The reason is because it is a perfect example of why we need to think outside of the box when it comes to STD prevention and that condoms cannot be the only defense in your tool kit. Like a great summer block buster movie, LGV has it all: a familiar big name star (Chlamydia), an interesting exotic backstory and even a mystery…or two.
Lymphogranuloma venereum (LGV) is a bacterial infection caused by a number of sub-types of the bacteria chlamydia trachomatis (types L1, L2, L2b and L3). These sub-types can have more serious consequences than the more common variants of chlamydia. They are more invasive and can spread beyond the mucosal lining (the tissue which covers various passages and cavities exposed to the air such as the mouth and rectum), causing inflammation and destruction of tissue.
Ok, think of this as a weird mutant brother of chlamydia. It is in the same family but transmission and treatment is a bit different. Also, it is not commonly tested for so you will need to ask for it specifically when visiting your doctor. You should be screened for LGV, and other STDs, every 3 months, even if you are not showing symptoms.
Until 2003, these strains of chlamydia were thought to only be in Asia, Africa and the Caribbean. When it began to show in the UK, those infected were thought to be travelers. A cluster in The Netherlands changed how the European Union began to address this STD. The greatest numbers and research, have been in the UK, Germany, France and, of course, The Netherlands, even though infection clusters are beginning to show in North America.
Here are some stats we found, for those of you that like to follow the numbers:
Between 2003 and 2008 a total of 849 individuals were diagnosed with LGV in the UK – the largest number of cases in Europe. All but five were MSM. Their average age was 37, three-quarters also had HIV and half had another STI at the time of LGV diagnosis. Cases were seen across the UK but concentrated in London, Brighton and Manchester. The number of cases recorded in 2009 and 2010 was higher than in previous years. However, in comparison to infections such as gonorrhoea and chlamydia, the numbers diagnosed with LGV remain low.
With numbers this small, you might wonder why we are concerned about this STD. The answer is based on the symptoms, how it is spread, the lack of full screening and the length of treatment. Let’s take a look at each one individually.
The Symptoms can be complex and severe, causing inflammation, lymph node infection, fever, muscular pain and general ill-health. Symptoms can develop on different parts of the body, such as the genitals, the anus, rectum, oral cavity and lymph nodes. There are three stages of infection and symptoms vary depending on which part of the body is infected. Some people with LGV may not experience any symptoms but they can still pass the infection to their sexual partners.
Stage one: A small painless blister or sore appears where the infection first entered the body: this may go unnoticed. If stage one occurs inside the anus then it may cause rectal inflammation or proctitis. This is the commonest symptom of LGV in MSM. The painful inflammation may result in ulceration, discharge, bleeding, constipation, and a feeling of needing to defecate (tenesmus). Fever and lower abdominal pains may develop. If you are experiencing ANY of these symptoms, please seek medical care immediately. They will not go away on their own and can become more severe and even permanent without treatment!
Stage two: Occurs two to six weeks later, usually after the appearance of an LGV ulcer somewhere. Inflamed and swollen lymph glands may then appear near the groin, armpit or neck. If untreated these can swell to large abscesses full of pus (buboes) which then burst through the skin.
Stage three: May occur months or years later if LGV is not diagnosed and treated. Chronic symptoms can become scarring, causing permanent damage to the affected area. Untreated rectal infection leads to rectal stricture which may require surgery. The penis and sac that contains the testicles can swell massively with fluid. Spread of the bacteria throughout the body can occasionally lead to arthritis or inflammation of the lungs.
Like most STDs in males, many are asymptomatic but for those that do show signs, this can be a very uncomfortable to painful infection. For the majority of gay males, this is an issue for those that “bottom” for anal sex and/or fisting.
The vast majority of patients have an anal infection of LGV but, oral and penile cases, though very rare, have been found. Because chlamydia is a bacteria, it is very easy to transmit and a transfer of bodily fluids is not necessary. The basics are the same as with other STDs; unprotected anal sex and/or fisting, toys. LGV is a major issues for bottoms and not tops, who seem to be more carriers than infected. This strange twist plays out in venues where multiple partners can be had within a short period of time, like a sex party, sauna and bathhouses.
“It has been suggested that, if man 1 has insertive anal intercourse with man 2, and then goes on to have insertive anal intercourse with man 3, LGV could be passed from man 2 to man 3. The transmitter of LGV does not have the infection himself, but his penis could transfer the bacteria from one man to another. This could also happen if he used a condom, but used the same condom for both partners. LGV can probably be passed in a similar way during fisting or fingering, even if a fisting glove is used, but not changed between partners. Transmission can also happen if enemas or douching equipment are shared without proper cleaning between partners.” (From Makingitcount.org.uk)
What this all means is that, without knowing it, a top can spread LGV to many, unsuspecting partners within a short span of time, even if he never had intercourse or shared bodily fluids, just by touching each of his partners” anus. This is why this STD is a concern for us. Gay males have been taught that condoms are the only protection we need and that sharing of bodily fluid is the main and sometimes only way to contract an STD. LGV shows that we must think broadly as it comes to sex and not forget the basics, like hand washing.
Many, but not enough, gay males know to get screened and tested for chlamydia. But usually this is for oral and penile infections with a urine sample. For LGV, there must be an anal swabbing. But this has also shown some issues as some guys have been positive for the STD, but the test results gave a false negative. This is one of the times you will need to be well informed and make sure that your doctor has taken into account your symptoms as well as the test results, and if necessary test again.
First-line treatment is usually with doxycycline 100 mg twice-daily for 21 days. Protocols using doxycycline are successful both in those who are and are not co-infected with HIV. This is the same medication used to treat traditional chlamydia infection but the length of time is much greater. Traditionally, treatment is once a day for one week. It is this longer course that causes great concern as many people are known to stop treatment if and when the primary symptoms cease. Because LGV is more invasive, the treatment is longer but two times a day for 21 days is a long time for a guy who never or rarely takes medication. This could lead to an increase of infections and re-infections. We strongly urge you to complete the full round of medication and then speak with your doctor before going back out to play.
What you can do
The first thing is get yourself educated. Even though LGV is not very common in the United States, just wait a moment, it will be. As more guys travel for work and sex, as well as the ease in contracting this STD, it will without a doubt show up in your city or town, if it has not already.
If you are a top, you have the best chance of spreading this illness, with or without your knowledge. Hand/penis washing with anti-bacterial soap between partners is very important. Also, do not stick your bare or covered fingers inside of the anus/rectum of random guys. This practice infects every guy along your path. This goes the same for dildos and other toys. Finally, if you are topping for anal intercourse, always use a fresh condom between partners. (yes, this must be said)
If you are a bottom, or the receptive partner, getting screened for LGV can keep you and other bottom guys safe. If you are infected, get treated and take the medication until completed. Regular testing, every 3 months, is advised for this very reason. Also, wash all toys and insertive objects before usage.
- Group Sex
Sex parties and public sex venues are going to take a huge PR hit by those within and outside of our community because of this STD. There are many that cannot wait to “slut shame” and stigmatize those who attend these sorts of events. But we at GMJ understand the value that they hold and support their operations as methods for safer sex education, condom distribution/usage as well as STD testing sites.
From our professional (and personal) research, we believe that one of the most common modes of transmission for LGV inside of these spaces is the common practice of “fingering”. This activity is not considered to be sexual intercourse, and of course, no bodily fluids are exchanged. But as explained above, one guy, with a busy finger could infect a large number of guys as he goes about his merry way. LGV and respect for a guys’ assholes, is a major reason this practice needs to stop. Not only is it invasive without permission, it can infect a man with a very nasty STD that will require 21 days of medication and down time.
We would like to thank those at Makingitcount.org.UK for their research as well as the Terrence Higgins Trust.