Lymphogranuloma Venereum Outbreak in Men Who Have Sex With Men (MSM) in Belgium, January 2004 to July 2005

Following an alert from the Netherlands in January 2004, health experts discovered an outbreak of lymphogranuloma venereum (LGV) in men who have sex with men (MSM) in Antwerp in 2004. ESSTI ALERT, a surveillance system that monitors sexually transmitted infection (STI) events, helped broadcast the alert.

In January 2004, HIV patients with a long history of anorectal symptoms came to the HIV/STI outpatient clinic at the Institute of Tropical Medicine in Antwerp. Doctors, who had not previously considered LGV a possible cause of the symptoms, confirmed two LGV cases in March that were epidemiologically linked to the Rotterdam outbreak.

"Subsequently, during routine STI medical care at our HIV/STI outpatient clinic, 9 confirmed LGV cases were detected between January and July 2005: Chlamydia trachomatis genotype L2 cases; genotyping with restricted fragment length polymorphism (RFLP). Eight cases were detected between January and November 2004. The last case was detected in July 2005," the authors reported.

The investigators also found four probable cases between January and November 2004 in patients with anorectal syndrome. "C. trachomatis PCR was positive on a rectal sample," according to the study, "but no samples were available for genotyping. Chlamydia IgG 1/1024 with indirect immunofluorescence (Chlamydia bivalent, ServiBio, France)."

All thirteen patients were white MSM: 12 HIV-positive, one of unknown serostatus. All thirteen had a history of anorectal symptoms, and six had had another STI in the year before the LGV check-up. Patients reported having sexual partners in Europe, Asia, South America and Central America. No other confirmed LGV cases were reported to Belgian health authorities between January 2004 and July 2005, the study said.

Public health officials organized a targeted prevention effort, alerting the gay press and coordinating activities with partner organizations in the Netherlands. Officials notified physicians in both the French- and Dutch-speaking parts of Belgium.

"It is hard to say whether the LGV outbreak is 'over,'" the authors noted. "The factors for a new outbreak of LGV or another STI are probably still present in the high risk groups."

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