In January 2004 Dutch authors reported an outbreak of lymphogranuloma venereum in men who have sex with men in the Netherlands, launching a European alert.w1 The UK Health Protection Agency began an initiative to raise awareness of lymphogranuloma venereum and improve its diagnosis and surveillance.^w2 Since then hundreds of cases have been identified in the United Kingdom, Europe, and the United States.

Lymphogranuloma venereum is a systemic sexually transmitted infection caused by Chlamydia trachomatis serovars L1-L3. Unlike the oculogenital strains (serovars A-K) of C trachomatis which cause mucosal disease, these organisms invade and destroy lymphatic tissue. Lymphogranuloma venereum has been considered a tropical sexually transmitted infection, endemic in parts of Africa, Asia, and the Caribbean but rare in the developed world. Men who have sex with men predominantly present with an anorectal syndrome of proctitis or proctocolitis rather than genital ulceration with inguinal “buboes” (inflammatory lymph node swellings …