An outbreak of a sexually transmitted disease usually seen only in the tropics has public health officials worried it is yet another signal that HIV infections are about to rise.
Lymphogranuloma venereum (LGV), caused by a bacteria that is part of the chlamydia family, is normally confined to the tropics of Africa, South America, Asia and the Caribbean. By the end of 2005 there were 30 recorded cases of LGV in Toronto.
"This is a new thing," said Dr. Robert Remis, a University of Toronto HIV/AIDS researcher. "It's hard to diagnose and it's a rather painful condition."The city is already in the grip of a syphilis outbreak, and both diseases are associated with an increased risk for HIV and AIDS.
Dr. Kelly MacDonald, chair of the Ontario HIV Treatment Network, said the two outbreaks are a serious concern. "It's a marker for high-risk sex and partner change," she said. "In every study with explosive rates of HIV you see syphilis."And LGV is a "tropical disease we shouldn't see" in Toronto, she added. "It means the rate of partner change is extremely high. Things like syphilis and LGV should be the first things we get under control," said MacDonald, a microbiologist at Mount Sinai Hospital.
LGV symptoms appear three to 30 days after exposure. It starts with a painless sore on the vagina, penis, rectum or oral cavity. The condition can be cured with three weeks of antibiotics, but left untreated it can cause scarring, deformity and, in rare cases, hepatitis and meningoencephalitis (infection of the brain and spinal cord tissues).
In Toronto, all but one of the 30 cases were found in gay or bisexual men, said Dr. Rita Shahin, associate medical officer of health. Cases of LGV have been recently reported in gay men in the Netherlands and other European countries.The current syphilis outbreak started in May 2002, mostly in gay or bisexual men, and peaked in 2004 with 368 cases. Last year there were 241."It's a true epidemic and related to an increasing rate of unsafe sexual behaviour," said Remis.Most gay men practise safe sex, but some still don't wear condoms. Just as condoms can prevent the transmission of HIV, they can also lower the chances of getting syphilis and LGV.
The odds of getting HIV/AIDS are increased by three to five times if you already have syphilis, according to the Public Health Agency of Canada. Thirty to 40 per cent of the new cases of syphilis since 2002 were seen in men co-infected with HIV, according to Remis. Almost all of the men with LGV were HIV-positive.An estimated 55,000 people in Canada live with HIV/AIDS. In Toronto, 15,300 people have the sexually transmitted disease; 10,700 of those are men.
Syphilis — which usually begins with a painless ulcer on the genitals — is easy to treat with a single, intramuscular shot of penicillin. But if the ulcer is small or hidden inside the vagina, throat or anus, it can be missed.As the syphilis progresses from a sore to its secondary phase, a rash develops on the palms of the hands and soles of the feet. It usually clears up on its own and the syphilis becomes latent, making its appearance 10 to 30 years later. When it comes back, the lesions can appear anywhere, including the heart, liver and brain. But if you have HIV or AIDS, syphilis can progress at an intensely rapid pace, infecting the brain and major organs in a year.
Health officials are trying to get the word out about syphilis, which can be easily transmitted during oral sex, by educating and encouraging testing in bathhouses and in the gay community.High-risk sexual behaviour among gay and bisexual men and an associated increase in HIV rates has been seen in New York City and Miami."Now we have people making decisions not to use condoms because they don't think the risk is that great and the outcome isn't that bad," said MacDonald.The popularity of recreational drugs could play a role. So could the lack of "fresh" messages teaching the public about the dangers of sexually transmitted infections, said Shahin.