WP 76 Outbreak of Lymphogranuloma Venereum (LGV) in Michigan

Wednesday, September 21, 2016
Galleria Exhibit Hall
James B. Kent, MS, Epidemiology / HIV-Body Art-Viral Hepatitis-STD, Michigan Department of Health and Human Services, Lansing, MI

Background:  LGV is a sexually transmitted infection caused by Chlamydia trachomatis and presents with proctitis, lymphadenopathy, or genital ulcers. LGV was dropped as a nationally notifiable condition in 1993 and is rarely reported. No cases were reported in Michigan between 2009 and 2014, but 32 cases were reported between 8/2015 and 3/2016. The surveillance and epidemiology of these recent cases is described.

Methods:  In 2015 Michigan Department of Health and Human Services (MDHHS) reported a cluster of four initial cases, developed a case definition, and arranged for confirmatory testing at the CDC laboratory. Confirmed Cases are positive for Chlamydia trachomatis L-genotypes. Probable Cases have both a positive Chlamydia result, and either compatible symptoms, or a sexual partner diagnosed with LGV. A Suspect Case has symptoms compatible with LGV, and is a partner of a case. MDHHS STD Disease Intervention Specialists provided partner notification services to each case. Treatment with 21 days of doxycycline was confirmed for each case. Staff attempted to locate partners for evaluation and treatment.

Results:  Through March 2016, 32 cases meeting the LGV case definition were reported, including 19 Confirmed Cases, 6 Probable Cases, and 7 Suspect Cases. All cases were among men who have sex with men, and all were HIV-infected. Five of the HIV infections were diagnosed within 30 days of the diagnosis of LGV. Three-quarters of cases were reported from one HIV clinic; three-quarters were African American, and three-quarters were residents of the City of Detroit. Twelve LGV cases were named as partners by other LGV cases, but additional partners were not infected or were un-locatable.

Conclusions: LGV appears to be routinely occurring in southeast Michigan among MSM who are HIV-infected. Most had previous diagnoses of a sexually transmitted diseases. All were healthy and more than half had undetectable HIV viral load results at their most recent evaluation.