Historically, lymphogranuloma venereum (LGV) was seen only in tropical areas as a sexually transmissible infection. In the last decades of the previous century, LGV was seen in countries with a moderate climate solely as an 'imported' disease. This changed in 2003, when the first cases of endemically acquired LGV proctitis were reported in the Netherlands among men who have sex with men (MSM), who were predominantly HIV positive. A disturbing association in this current epidemic is the high prevalence of hepatitis C among patients diagnosed with LGV. Since then, an ongoing epidemic in Western society has been revealed which has been dated back to 1981. In this chapter, diagnostics, treatment and common complications concerning LGV are discussed. Moreover, we focus on the epidemiological background of the recent epidemic of LGV among MSM in Western society and the associated risk factors. Early diagnosis is important to prevent irreversible late complications like anal strictures, mega colon and chronic fistulas. There is an urgent need for less expensive diagnostic assays for screening purposes to prevent more expansive transmission within the community. The microbial and immunological background of LGV infection in relation to HIV should be studied in detail and could help to explain the considerable number of asymptomatic LGV cases.