Lymphogranuloma venereum (LGV) was formerly known as a sexually transmissible infection confined to equatorial regions, but also as an "imported" sexually transmissible infection in the Western world. However, since 2003, with the first cases of LGV proctitis among men who have sex with men reported in the Netherlands, an ongoing epidemic has been revealed in Western society dating back to at least 1981. In this article a case of LGV proctitis is presented, and the state of the art diagnostics, treatment and common complications concerning LGV are discussed. Moreover, risk factors and the background of the recent epidemic of LGV in the Western world among men who have sex with men are summarized. There is a need to develop new diagnostic assays, to prevent complications and to protect the community from more expansive transmission. Shorter antibiotic treatment courses for LGV are necessary but require large controlled clinical trials. 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.