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Background: Genital and extra-genital chlamydial infections are nationally reportable in Canada, however, lymphogranuloma venereum (LGV) is excluded from the national case definition. Within this context, and in response to emerging outbreaks of LGV among men who have sex with men (MSM) in Europe, a national enhanced surveillance system for LGV was initiated in 2005. This analysis describes the features of the LGV situation in Canada.
Methods: When clinical presentation is suggestive of LGV in chlamydia-positive cases, confirmatory testing is performed by the National Microbiology Laboratory. Provincial/territorial health authorities use a standardized national case report form to collect enhanced epidemiological data on each case, where possible, and submit the data to the Public Health Agency of Canada.
Results: As of December 31, 2011, 113 confirmed and 65 probable cases of LGV have been reported. With the exception of three probable cases in women, all cases were reported in men. Case report forms were received for 85 confirmed cases, all male. Response rates for specific data elements varied. Seventy-one of the 85 cases (83.5%) were aged 30 and older. The majority of cases (96.2%; 75/78) were MSM, and 3.8% (3/78) were of unknown sexual orientation. Travel-related sex was reported by 21.5% (17/79), and 66.7% (22/33) reported having unprotected sex in the 60 days prior to symptom onset. HIV co-infection was reported for 71.1% of cases (32/45), and 12.5% (5/40) were co-infected with hepatitis C.
Conclusions: In Canada, LGV is still uncommonly reported compared to other sexually transmitted infections, and is seen primarily in MSM who are co-infected with HIV. It is uncertain to what extent changes in testing patterns and laboratory procedures affect observed trends in diagnostic rates. Up-to-date epidemiological information on LGV will be used in an upcoming review of national guidelines for the diagnosis and management of LGV.