San Francisco public health officials on Monday sounded the alarm in the US about a rare and "potentially debilitating" sexually transmitted disease known as lymphogranuloma venereum, or LGV - which was reported recently in the Netherlands - turned up among a small number of MSM patients in the city.

The disease is a form of the common sexually transmitted infection chlamydia - but this particular strain can cause scarring of the genitals and colon, and can produce a swelling and bursting of lymph glands near the groin. Also unlike routine cases of chlamydia, LGV can cause severe urinary and/or gastrointestinal distress, including inflammation and bleeding of the rectum and colon. Men who suffer from rectal symptoms are most likely to have acquired the infection through unprotected anal intercourse. However if caught in time, the illness is treatable with antibiotics.

"The idea is to knock it out quickly. If it circulates widely, it could be quite challenging," said Dr Sam Mitchell, an epidemiologist at the San Francisco Department of Public Health (SFDPH).

Although LGV has been primarily seen in developing regions, including Africa, Southeast Asia, Latin America and the Caribbean, doctors in Rotterdam reported 92 cases among gay men during a 17-month period ending in September while isolated cases have also been reported in Belgium, France, Sweden and Atlanta (Georgia, US).

In early December, the SFDPH identified a gay male patient infected with LGV and later identified three additional LGV cases among patients who were treated for more common types of chlamydial infections earlier this year. Prior to 2004, there were only three cases of LGV reported in San Francisco since 1998, and none since 2001. Chlamydia and LGV are not transmitted through casual contact.

None of the four patients who were found to have the bug in San Francisco had visited the Netherlands, an indication there may be other cases yet to be discovered in the city, said Dr Mitchell.

As it is difficult to distinguish early infections of LGV from the more benign microbes, Dr Mitchell said the city is recommending that doctors treat all cases of rectal chlamydia with the three-week regimen. "We think doctors should err on the side of caution," he said.

San Francisco Department of Public Health warning
The SFDPH is alerting individuals who practice receptive anal intercourse that if they have symptoms of proctitis (itching anus, blood or mucus in the stool, straining and cramping when having a bowel movement), that they should seek medical care. In addition, if they are diagnosed with LGV, they should contact sex partners so that their partners can be treated to stop the spread of this disease. LGV is diagnosed by a clinical examination plus several laboratory tests and is effectively treated with common antibiotics such as doxycycline. For further information, please see: www.sfcityclinic.org/providers.