In 2019, the World Health Organization (WHO) issued a startling report, revealing a concerning surge in sexually transmitted infections (STIs) worldwide, with more than one million new cases of curable STIs reported daily (1). This alarming increase was substantiated by data from the American and European Annual Epidemiological Reports for the years 2017-2019, showing significant rises in the notification rates for infections caused by Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (2, 3).
Incidence of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum
Here’s a breakdown of the incidence of these three STIs in Europe and the rest of the world, based on the latest available data from the World Health Organization (WHO):
Neisseria gonorrhoeae (gonorrhea):
- Global: 0.7% [0.5-1.1%] for adults 15-49 years old, with an estimated 78 million new cases annually.
- Europe: 0.3% [0.1-0.5%] for adults 15-49 years old, with an estimated 4.5 million new cases annually.
Chlamydia trachomatis (chlamydia):
- Global: 3.2% [2.7-3.9%] for adults 15-49 years old, with an estimated 129 million new cases annually.
- Europe: 2.7% [2.2-3.5%] for adults 15-49 years old, with an estimated 40 million new cases annually.
Treponema pallidum (syphilis):
- Global: 0.6% [0.5-0.7%] for adults 15-49 years old, with an estimated 6 million new cases annually.
- Europe: 0.11% [0.09-0.13%] for adults 15-49 years old, with an estimated 130 thousand new cases annually.
Key takeaways:
- Europe: The WHO European Region exhibits the lowest STI prevalence among all WHO regions for all three STIs.
- Global: Chlamydia is the most prevalent of the three STIs globally, followed by gonorrhea and then syphilis.
- Regional variations: The incidence of these STIs varies significantly between regions and countries within Europe and the rest of the world. Factors such as access to healthcare, sexual health education, and socioeconomic conditions play a role in these variations.
Additional resources:
- WHO Global and regional STI estimates: https://www.who.int/news/item/24-07-2023-who-releases-new-guidance-to-improve-testing-and-diagnosis-of-sexually-transmitted-infections
- ECDC: https://www.ecdc.europa.eu/en
- CDC: https://www.cdc.gov/std/default.htm
Please note:
- These are estimates and actual numbers may be higher due to underreporting and asymptomatic cases.
- The data provided is for adults 15-49 years old.
- It is important to consult a healthcare professional for diagnosis and treatment of any STI.
The mounting concern over the escalating global STI crisis prompted the 75th World Health Assembly to revise its global health sector strategy, including HIV, hepatitis, and STIs, within the same agenda for the years 2022-2030 (4). One of the most worrying aspects of this epidemic is the significant increase in lymphogranuloma venereum (LGV) cases, infections caused by the L1-L3 genotypes of Chlamydia trachomatis.
The 2019 European Annual Epidemiological Report for LGV reported a staggering 30% increase in diagnoses compared to the previous year, with 2,389 cases reported in 2019, up from 1,989 in the prior year (5). However, this surge is not evenly distributed, as a substantial 86% of all LGV diagnoses in Europe were concentrated in just four countries: the United Kingdom, France, the Netherlands, and Spain, indicating disparities in LGV testing and reporting (5).
LGV Epidemic Origins and Spread
The current LGV epidemic, primarily associated with men who have sex with men (MSM), was first identified in the Netherlands in 2003 (6). However, it quickly spread to other European countries, North America, and Australia (7). This rapid dissemination was attributed to the emergence of a new L genotype known as the L2b variant (8).
In the early years, this L2b variant was responsible for most, if not all, LGV cases (9). Initially, some European countries reported the circulation of non-ompA-L2b genovariants (10, 11), but subsequent genomic sequencing studies revealed that all these genovariants ultimately derived from L2b (12).
Recent research has unveiled a concerning trend in LGV diagnoses, with an increase in cases among asymptomatic patients (13). This suggests that the spread of undiagnosed LGV is promoting the selection and dispersal of less virulent genovariants, complicating the epidemiological landscape.
Longitudinal Analysis and Study Objectives
Despite the gravity of the LGV epidemic, few studies have comprehensively analyzed the spread and diversification of the L2b genotype and its associated genovariants over an extended period (15, 16). In a prior LGV European collaborative study, Spain exhibited the highest diversity rate (12).
In response to this urgent public health concern, our study aims to fill this research gap. We conducted an in-depth analysis of the temporal evolution of LGV infections at four medical centers in Madrid, each representing distinct clinical settings and target populations. Our primary objectives include characterizing the emergence, diversification, and spread of L2b genovariants to inform more effective strategies for LGV management and control.
TABLE 1 – Lymphogranuloma Venereum (LGV): A Deep Dive into a Less-Known STD
Lymphogranuloma venereum (LGV), often shrouded in obscurity, is a sexually transmitted disease (STD) caused by specific strains of the Chlamydia trachomatis bacteria. While not as prevalent as some other STDs, it can have devastating consequences if left untreated. This article aims to shed light on LGV, delving into its causes, symptoms, diagnosis, treatment, and potential complications.
The Bacterial Culprit:
LGV is caused by three unique serotypes of Chlamydia trachomatis: L1, L2, and L3. Unlike the strains responsible for common chlamydia infections, these serotypes invade deeper tissues, causing a more severe and chronic course of infection.
Stages of a Silent Threat:
LGV typically progresses in three stages, each with distinct symptoms:
Stage 1 (1-3 weeks after infection):
- Small, painless genital ulcers or papules (skin bumps) that often go unnoticed.
- Swollen lymph nodes in the groin, usually on one side, but sometimes on both.
- Fever, chills, and headache may occur.
Stage 2 (Weeks to months after initial infection):
- Swollen lymph nodes in the groin may become tender, suppurate (form pus), and even break open.
- Genital sores may heal, leaving scars.
- In some cases, rectal involvement can lead to pain, discharge, and difficulty with bowel movements.
Stage 3 (Months to years if untreated):
- Chronic inflammation and scarring can damage the lymphatic system, leading to elephantiasis (thickening and hardening of tissue) of the genitals and rectum.
- Scarring can also restrict the flow of lymph fluid, leading to fistulas (abnormal connections) between organs.
- Genital ulcers may recur.
- Joint pain and arthritis can develop.
Diagnosis and Treatment:
Early diagnosis of LGV is crucial to prevent complications. Several methods can be used:
- Laboratory tests: PCR tests detect the LGV-specific Chlamydia strains in urine, blood, or swabs from ulcers or lymph nodes.
- Serological tests: These tests detect antibodies against Chlamydia, but cannot distinguish between LGV and other chlamydial infections.
- Imaging tests: X-rays or ultrasounds may be used to assess the extent of internal damage.
Treatment for LGV involves prolonged courses of antibiotics, typically macrolides like azithromycin or doxycycline. Early treatment can resolve the infection and prevent complications. However, advanced cases may require surgery to repair fistulas or manage elephantiasis.
Living with LGV:
Living with LGV can be physically and emotionally challenging. Chronic pain, sexual dysfunction, and the stigma associated with an STD can significantly impact quality of life. Support groups and mental health services can be invaluable in navigating these challenges.
Prevention is Key:
Practicing safe sex, including using condoms consistently and correctly, is the best way to prevent LGV. Regular STD testing is also crucial, especially for individuals with high-risk behaviors.
Raising Awareness:
The lack of awareness about LGV contributes to its delayed diagnosis and potential complications. Educating healthcare professionals, communities, and individuals at risk is essential for early intervention and preventing the spread of this disease.
While LGV may not be as common as other STDs, its potential for severe consequences makes it a critical public health concern. Increasing awareness, promoting testing and early diagnosis, and ensuring access to appropriate treatment remain crucial in combating this often-silent threat.
This article is intended for informational purposes only and should not be interpreted as medical advice. Please consult your healthcare provider for diagnosis and treatment of LGV or any other medical condition.
Additional Resources:
- Centers for Disease Control and Prevention (CDC): https://www.cdc.gov/std/treatment-guidelines/lgv.htm
- World Health Organization (WHO): https://www.cdc.gov/std/treatment-guidelines/lgv.htm
- American Sexual Health Association (ASHA): https://www.ashasexualhealth.org/
reference link : https://journals.asm.org/doi/10.1128/spectrum.02855-23
