Epidemic Lymphogranuloma venereum during epidemics of crack cocaine use and HIV infection in the Bahamas.
BACKGROUND
Since the early 1980s, the Bahamas has experienced sequential epidemics of freebase/crack cocaine use, genital ulcer-inguinal adenopathy disease (GUD), and heterosexual HIV infection.


OBJECTIVE
To prospectively define the etiology of GUD in patients at the Princess Margaret Hospital during outbreaks of crack cocaine use, GUD, and HIV infection in the Bahamas.


METHODS
In Nassau, 47 consecutive patients with GUD underwent serologic testing for syphilis and for infections with HIV, herpes simplex virus type 2 (HSV-2), and Chlamydia trachomatis. Genital ulcer specimens were tested by culture and/or polymerase chain reaction (PCR) assay for Haemophilus ducreyi; by PCR and/or antigen assay for HSV; and by PCR for C trachomatis. Lymph node aspirates were tested by PCR for C trachomatis and H ducreyi.


RESULTS
Twenty patients (43%) had HIV infection; eight had lymphogranuloma venereum (LGV), confirmed by PCR detection of C trachomatis sequences consistent with the L2 serovar; and nine others had possible LGV, on the basis of serum microimmunofluorescent C trachomatis antibody titers > or =256. Inguinal lymphadenopathy or bubo was present in 15 of 17 patients, who thus met the laboratory criteria for definite or possible LGV, and in 7 of 30 who did not meet such laboratory criteria (P < 0.001). Thirteen patients had confirmed genital herpes, seven had confirmed chancroid, and four had probable or possible primary syphilis.


CONCLUSIONS
The epidemics in the Bahamas of crack use, heterosexual HIV infection, and GUD apparently included epidemic transmission of LGV.
Bauwens
J Eric
JE
University of Washington Division of Infectious Diseases, Seattle, USA.
Orlander
Herbert
H
Gomez
M Perry
MP
Lampe
Mary
M
Morse
Stephen
S
Stamm
Walter E
WE
Cone
Richard
R
Ashley
Rhoda
R
Swenson
Paul
P
Holmes
King K
KK
D000328:Adult; D001444:Bahamas / Q000453:epidemiology; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D019970:Cocaine-Related Disorders / Q000150:complications / Q000453:epidemiology*; D017931:DNA Primers; D004196:Disease Outbreaks; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D015497:HIV-1 / Q000302:isolation & purification; D015498:HIV-2; D006191:Haemophilus ducreyi / Q000302:isolation & purification; D018258:Herpesvirus 2, Human / Q000302:isolation & purification; D006801:Humans; D008219:Lymphogranuloma Venereum / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000821:virology; D008297:Male; D016133:Polymerase Chain Reaction; D011446:Prospective Studies
D017931:DNA Primers