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

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