Syphilis and Lymphogranuloma Venereum Resurgence
Toronto is experiencing a significant increase in the number of reported cases of infectious syphilis and lymphogranuloma venereum (LGV) in men who have sex with men (MSM). In 2014, 590 cases of infectious syphilis were reported to TPH; that increased to 690 in 2015 and 394 for the first six months of 2016. Approximately 97-98 % of infectious syphilis cases are reported in men and in 2015, 89% of male cases reported having had sex with a partner of the same sex, 45% of individuals with syphilis are co-infected with HIV. In 2015, 28 LGV cases were reported in Toronto, that number increased to 39 cases in the first six months of 2016. All cases were reported in men and 48% of individuals diagnosed with LGV are co-infected with HIV.
Lymphogranuloma venereum (LGV) is a sexually transmitted infection, caused by chlamydia serovars L1, L2, and L3. Infections caused by these chlamydia serovars invade lymph tissue and tend to be more invasive than those caused by non-LGV chlamydia. Signs and symptoms include painful, ulcerative proctitis, with inguinal and/or femoral lymphadenopathy or buboes, accompanied by fever, myalgia and arthralgia. Diagnosis of LGV is not straightforward, as its symptoms can be confused with other infections or conditions. When a health care provider suspects the presence of LGV, they will need to send a lab requisition requesting LGV testing for specimens positive for chlamydia.
Action Statement for Health Care Providers
All patients who are sexually active, especially MSM should be informed of the current outbreak and offered testing. Patients who are HIV positive are at a higher risk of serious complications from syphilis, including neurosyphilis. HIV positive patients at risk for syphilis should be tested every 3 months.
Health care providers are reminded about the importance of testing MSM who may be engaging in unprotected anal or oral sex regularly for sexually transmitted infections. Testing should include pharyngeal and rectal swabs based on sexual history. Suspected cases of LGV should be treated empirically with doxycycline while awaiting test results.