Lymphogranuloma venereum, an invasive and destructive sexually transmitted infection with many faces

Lymphogranuloma venereum (LGV) is a serious, invasive, ulcerative sexually transmitted infection caused by Chlamydia trachomatis serovar L1, L2, and L3. Until 2003, we saw LGV among the general population of low- and middle-income countries. Since 2003, we have also seen LGV in high-income countries but exclusively in men who have sex with men. The number of patients with LGV has increased in the last decade, and the proportion in men who have sex with men without HIV has increased dramatically. In low- and middle-income countries, LGV affects women and men and often causes genital complaints. In the men who have sex with men in the population in high-income countries, the vast majority of men suffer from anorectal infections that mimic chronic inflammatory bowel diseases like Crohn disease. LGV is not always directly recognized, because the presentations are often nonspecific and additional diagnostics are not distinctive. When sexually transmitted infections are not considered in the diagnostic work-up, consequent delay and inappropriate treatments can occur. In patients with anorectal complaints, a properly conducted sexual history followed by a sexually transmitted infection diagnostics is key to diagnose LGV. Early recognition and adequate antibiotic treatment can prevent complications and unnecessary additional diagnostic procedure, halting further transmission.