Confirmed cases of Lymphogranuloma venerum in Michigan

Date Sent: 10/22/2015 10:11 AM EDT
Sender: Michigan Health Alert Network
Subject: Confirmed cases of Lymphogranuloma venerum in Michigan

Message:
Two cases of confirmed, six cases of probable, and four suspect cases of lymphogranuloma venerum (LGV) have been reported in Michigan as of October 2015; up from 4 probable cases reported in the health alert sent on September 29, 2015. The majority of these cases have been reported by a single health care facility in Southeast Michigan. Current cases live in Wayne, Oakland, and Macomb counties. The initial case was reported in August and the most recent was diagnosed in early October.

LGV is a rare and poorly characterized STD in the U.S. with the last reported case in Michigan occurring in 2008. LGV is caused by a serological variant of Chlamydia trachomatis. The Centers for Disease Control and Prevention (CDC) has been working with the Michigan Department of Health and Human Services (MDHHS) on managing this outbreak. MDHHS staff have been conducting partner elicitation and contact tracing with cases and referring partners for testing and treatment.

The confirmed, probable, and suspect cases are nearly all among African American men who have sex with men (MSM) who also have HIV. Many of the reported cases are contacts of each other and have met partners online. Commonly reported symptoms have been penile lesions, anogenital symptoms, and inguinal lymphadenopathy; please refer to the attached case definition for a more specific list of LGV-associated symptoms. Providers seeing patients with these symptoms should consider LGV in their differential diagnosis, especially among MSM in Southeast Michigan with symptoms and for those with positive chlamydia tests whose symptoms do not resolve with standard treatment.

In persons with a clinical presentation compatible with LGV infection, nucleic acid testing for Chlamydia trachomatis of the affected area (e.g. anal swabs and/or swabs of ulcers) is indicated. Urine nucleic acid testing will frequently be negative. Samples that test positive should be forwarded to MDHHS laboratories for referral to CDC for specialized testing. Details on proper specimen collection methodologies are attached.

The recommended treatment regimen for LGV is Doxycycline 100 mg orally twice a day for 21 days. Sexual partners of a probable or confirmed LGV case should be tested for chlamydia infection and presumptively treated with doxycycline 100 mg orally twice a day for 7 days. Given the context of this outbreak, where cases are occurring among HIV-infected persons or persons at elevated risk of HIV infection, 21 days of treatment should be considered.

All information related to clinical and laboratory reports on suspected or probable cases should be made to Jim Kent at 517-335-8247 or kentj3@michigan.gov and entered into the Michigan Disease Surveillance System (MDSS).

Further questions about this health alert can be directed to Karen Krzanowski at 517-241-0870 or krzanowskik@michigan.gov.

Attachments:

• LGV Case Definitions.pdf
• RECTAL OR LESION SWAB COLLECTION PROCEDURE FOR CDC LGV PCR TESTING.pdf
• CDC guidance for specimen submission for laboratory confirmation of LGV.pdf