Until 2003 lymphogranuloma venereum (LGV), a disease caused by the more invasive L serovars of Chlamydia trachomatis, was considered a rare disease outside resource poor countries. Since then it has emerged as a significant problem among men who have sex with men (MSM) in Europe. In 2003 an outbreak of LGV was recognised in Rotterdam in the Netherlands.¹ More than 100 men have been reported in this outbreak, most of whom were HIV positive and many had concomitant sexually transmitted infections including hepatitis C infection. Although many reported unprotected anal sex as a risk factor for acquisition of LGV, fisting and the sharing of sex toys also appeared as possible routes of transmission. Almost all presented with proctitis and symptoms included rectal pain, discharge, tenesmus, and other signs of lower gastrointestinal inflammation including constipation and abdominal pain. Some reported systemic symptoms such as fever and malaise. Genital and inguinal symptoms were rare with only one patient presenting with inguinal lymphadenopathy.

Since that report similar outbreaks have been …