The findings and conclusions in these presentations have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.

Tuesday, May 9, 2006

Enhanced Surveillance for Lymphogranuloma venereum in New York City

Preeti Pathela1, Jennifer Baumgartner1, Susan Blank2, Damarys Cordova2, Lillian Lee3, Ronald Limberger4, Heather A. Lindstrom5, Catherine Mclean5, John Papp6, and Julia A. Schillinger2. (1) STD Control, New York City Department of Health & Mental Hygiene, 125 Worth Street, Room 207, CN 73, New York, NY, USA, (2) Bureau of Sexually Transmitted Disease Control, NYC DOHMH / Division of STD Prevention, CDC, 125 Worth St., Room 207, CN-73, New York, NY, USA, (3) PHL, New York City Department of Health and Mental Hygiene, New York, NY, USA, (4) Wadsworth Center, New York State Department of Health, Albany, NY, USA, (5) Division of STD Prevention, CDC, 1600 Clifton Rd, MS E-02, Atlanta, GA, USA, (6) Division of STD Prevention, Centers for Disease Control, Atlanta, GA, USA

Lymphogranuloma venereum (LGV) is reportable in New York City (NYC). In early 2005, NYC Bureau of STD Control (BSTDC) alerted physicians to LGV signs/symptoms and invited submission of anorectal, urethral, and endocervical specimens for testing. BSTDC attempts to interview LGV and primary and secondary (P&S) syphilis cases.

To describe LGV cases, and compare interviewed LGV and P&S syphilis cases to assess (for intervention) whether both STDs affect similar populations.

We described tested persons using information from LGV testing visits, and compared behavioral data from interviewed 2005 LGV cases (n=10) and male 2004 syphilis cases (n=247).

From December 2004-October 2005, 169 specimens were received for LGV testing. Most were from males (94%) and submitted by private providers (69%). Clinical presentations were: proctitis (76%); lymphadenopathy (6%); partner referral (7%); genital lesions (10%); and non-LGV-like (1%). Among 132 male anorectal swabs, 43 (33%) were Chlamydia (Ct)-positive; of genotyped specimens, 66% (23/35) were LGV. LGV cases were: 39% White, 35% Black; median age 30; 96% men who have sex with men (MSM); 83% HIV co-infected (versus 55% among Ct-negative or Ct-positive/non-LGV cases). STD history was documented for 61%; 52% (12/23) had prior syphilis. Of MSM with LGV, 81% reported unprotected receptive anal intercourse (past 6 months). LGV and syphilis cases had similar age and race/ethnicity. Compared to interviewed LGV, interviewed syphilis cases were similar in MSM status, anonymous partners (60%), drug use, never discussing HIV status before sex (30%), and meeting partners in public sex venues (42% internet).

Most tested patients did not have classical ulcer/lymphadenopathy syndrome. Primary lesions may be undiagnosed, or proctitis may be a primary presentation. Demographics, behaviors, and syphilis history indicate overlap between LGV and P&S syphilis subpopulations.

Private providers, particularly HIV-care providers, should consider LGV in the differential of proctitis. Outreach efforts may be piggybacked onto existing syphilis activities.