New Detection of an STD Not So New to the U.S. Prompts Fresh Concerns

Within the past year there has been considerable publicity about a new outbreak of lymphogranuloma venereum (LGV). LGV is a serious sexually transmitted disease caused by a particularly aggressive strain of Chlamydia trachomatis that is considered a distinct biovar. This disease is generally considered to be one that is usually seen in tropical countries. But in 2003, it was detected in the Netherlands, followed by sporadic reports of cases from other countries in Western Europe and North America. A major concern has been that this disease can enhance HIV transmission. Public health authorities have expressed concerns about the possible spread of this disease into the United States.

Julius Schachter, PhD, in his editorial in the June 2005 issue of Sexually Transmitted Diseases, points out that this disease has actually been present in the United States for many decades and suggests that it is endemic in this country. In the U.S., the major clinical manifestation is proctitis in men who have sex with men, rather than the typical presentation of genital ulcers and bubos that is characteristic in developing countries. Schachter suggests the recent detection of cases in the U.S. actually reflects the use of sophisticated diagnostic tests capable of differentiating the LGV infection from the more common chlamydial infections that are highly prevalent. In other words, this is not a newly introduced disease or a new epidemic, but simply an application of new technology that is identifying infections which have not been previously recognized yet have been present in the United States all along.

Schachter is professor of laboratory medicine in the Department of Laboratory Medicine for the University of California San Francisco. Schachter is also past-president of the American Sexually Transmitted Disease Association and chair of the Sexually Transmitted Diseases Diagnostics Initiative of the World Health Organization. His current research focuses on the epidemiology and clinical manifestations of chlamydial infections, as well as the evaluation of newly developed diagnostic methods for chlamydial infections.