Date Sent: 09/29/2015 03:31 PM EDT
Sender: Michigan Health Alert Network
Subject: Cluster of Lymphogranuloma venereum in Michigan
Four cases of probable lymphogranuloma venereum (LGV) have been reported to Public Health by a southeast Michigan health care facility over the past six weeks. The first case was reported in mid-August, and three additional cases were reported last week. LGV is a rare STD in the U.S.; the last reported case in Michigan occurred in 2011. LGV is caused by a serologic variant of chlamydia trachomatis. CDC has been notified and is providing consultation.
All four cases are African American men who have sex with men (MSM). All have chronic HIV infection with low or undetectable viral load that is controlled by treatment. Three cases have multiple prior diagnoses of sexually transmitted infections. Two of the cases are linked and partner services follow-up is ongoing for all four cases.
There are likely to be additional undiagnosed cases in our community, although there are no recognized LGV outbreaks in other parts of the U.S. Clinicians treating patients from southeast Michigan should consider LGV in the differential for patients (especially MSM) with unresolved symptoms commonly seen in syphilis, herpes, or chancroid. Genital ulcers that do not resolve with treatment, inguinal lymphadenopathy, and anogenital symptoms may all be related to LGV.
Clinical LGV diagnoses may be confirmed by swabs of the affected ulcer or anal area that are positive for chlamydia trachomatis. Urine NAAT tests will often be negative for chlamydia. In addition, serum should be submitted to commercial labs for chlamydia antibody differentiation tests. The recommended treatment for LGV is 100 mg doxycycline for 21 days.
Communication about this Health Alert should be made to Karen Krzanowski at KrzanowskiK@michigan.gov
Clinical and laboratory reports of potential cases of LGV should be made via MDSS, or directly to Jim Kent, 517-335-8247.