On Monday, San Francisco public health officials warned that four gay men in the city have contracted a rare and potentially debilitating STD, Lymphogranuloma venereum (LGV), which was recently reported in the Netherlands.

LGV -- a form of chlamydia rarely seen outside of poor, tropical nations -- can cause genital and colon scarring, and can produce a swelling and rupturing of lymph glands near the groin. Rotterdam doctors reported 92 cases among gay men during a 17-month period ending in September. Isolated cases have also been reported in Belgium, France, Sweden and Atlanta.

In November, San Francisco City Clinic doctors treated one man with LGV, and subsequent testing of more than 100 previously stored rectal chlamydia specimens from patients turned up three more LGV cases. None of the infected patients had visited the Netherlands, so there may be other people with undiagnosed LGV in the city, said Dr. Sam Mitchell, a Department of Public Health epidemiologist.

Some LGV-infected San Francisco patients also had HIV. While there is no sign HIV-positive patients are at higher risk for LGV-related complications, patients might be more likely to contract HIV because of the ulcerations caused by LGV, said Mitchell.

Because early LGV infections are difficult to distinguish, officials recommend treating all rectal chlamydia cases with the three-week course of antibiotics used to successfully treat LGV. A single dose is usually required for more common chlamydia strains. "The idea is to knock it out quickly. If it circulates widely, it could be quite challenging," said Mitchell. "We think doctors should err on the side of caution."

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