Lymphogranuloma venereum (LGV) is a sexually transmissible infection (STI). It has occurred in outbreaks in Western Europe and North America. Since talking about sexual health lately is no longer a taboo in our area, I visited a clinic in Hamra (close to Costa cafe, same building as SGBL) recommended by a friend to talk to a young doctor who reported recently the first case of LGV in Lebanon in an HIV-negative MSM (Man who has sex with a man). A very calm and welcoming environment you get its vibes once you get the “blue-ashy” clinic of Dr. Ismaël Maatouk, a Dermato-Venereologist who works in Beirut, and welcomes all patient with no discrimination based on sexual orientation and gender identity for more than 3 years. Dr. Maatouk, have in his records more then 40 publications and several appearances in worldwide conferences talking about STI’s.
Below are his answers to some of my questions:
What is LGV?
It is an infection caused by three types (L1, L2 and L3) of the bacterium Chlamydia trachomatis.
IS it the same Chlamydia we know?
Yes, the same bacteria, but different sub-types.
Is it a new described infection?
No, it is an old infection and since 2003, initial clusters of LGV cases in MSM were reported in the Netherlands followed by a series of outbreaks in Europe, North America and Australia, mainly among HIV-positive MSM. However, it is not an MSM disease: it can infect sexually active people.
Is this infection frequent in MSM in those countries?
A large study in MSM from London and Brighton showed an estimated prevalence of LGV of 0.90% in the rectum and only 0.04% in the urethra.
Is it also present in the pharyngeal area, like the other types of Chlamydia?
Yes, Chlamydia is known to be found during standard STI screening of the urethra, rectum, pharyngeal mucosa. The prevalence of pharyngeal Chlamydia in London MSM is 1.2%.
What is the clinical presentation of this infection?
The classical presentation of LGV is inguinal lymphadenitis and abscess formation sometimes preceded by anogenital ulceration. Which means that we rarely find the genital ulceration associated with LGV because it is transient. Following this transient ulceration, we have an inflammation of the lymphatic ganglia that drains the region, which can be painful and can lead the patient to ask for a consultation. This inflammation looks like an abscess.
Is there any test we can perform to confirm the diagnosis?
Yes, a test based on PCR.
Is the treatment difficult?
No, it is a 3-week course of doxycycline.
Do we search for this disease in Lebanon?
In a routine consultation, No. The test is expensive.
I have read that recently, you reported the first case of LGV in Lebanon. Was it in a HIV-positive MSM as well?
No, it was in a HIV-negative MSM. However, it can infect any patient, regardless of HIV status and sexual orientation.
Do you see other STIs in your clinic? I mean severe cases like syphilis? Are these cases frequent?
We have syphilis, they are definitely not frequent, but they exist.
What do you think of LebMASH?
I really appreciate the work that these doctors are doing. Helping and being there for the LGBT community is what we need in our days. I support them to the maximum.
Special thanks to Doctor Ismaël Maatouk