A spike in the number of cases of a relatively rare sexually transmitted infection in the Dublin area of Ireland has prompted an investigation by Irish health authorities.

Ireland map/CIA
Ireland map/CIA

Since May 2014, officials report seeing 35 cases of the bacterial disease, Lymphogranuloma venereum (LGV), primarily in Dublin’s men who have sex with men.

Health authorities say this is the first such outbreak in Ireland, which was initially declared last October.

All cases are men who have sex with men and most are also HIV-positive.

Also known as Lymphogranuloma inguinale and tropical bubo, Lymphogranuloma venereum (LGV) is a sexually transmitted chlamydial infection caused by three related but distinct types of Chlamydia trachomatis (L-1, L2 and L-3).

These are different than the types that cause non-gonococcal urethritis/cervicitis in men and women respectively.

Though LGV is more common in tropical and subtropical parts of the world; it is seen in outbreaks in the United States and Western Europe particularly in men that have sex with other men.

This bacterium is transmitted primarily through sexual contact (oral, genital or anal) and with any direct contact with open lesions. It is believed to be transmissible via skin to skin contact.

The infection is characterized by small painless papules, nodules or ulcers which may form on the penis or within the urethra in men, and on the vulva, vaginal wall or cervix in women. This lesion frequently may go unnoticed. It may take from 3-30 days before the primary lesion appears.

Lymph nodes in the area near the infection typically swell and the presence of inguinal or femoral buboes may be seen. In women these external node are rarely affected, but proctitis may be the result of swelling of the pelvic nodes extending to the rectum.

For those that practice rectal intercourse, proctitis may be a manifestation of the disease. Rectal ulcers, discharge, pain and bleeding are also common presentations.

Elephantiasis of the genitals in both men and women may occur in cases of untreated LGV.

Like other ulcer forming sexually transmitted infections (STI) like syphilis, chancroid and herpes; LGV increases the chance of getting HIV.

LGV can be treated successfully with antibiotics (doxycycline with azithromycin as an alternative) for all stages of infection including lesions and buboes.

As with other ulcerative STI’s, LGV can still be transmitted even with condom use if infected areas are not covered.