What’s Old Is New: the Evolution of Lymphogranuloma Venereum Proctitis in Persons Living with HIV

Purpose of Review Lymphogranuloma venereum (LGV) has re-emerged as a consequential anorectal sexually transmitted infection with high burden among persons living with HIV, especially men who have sex with men (MSM). Recent Findings Surveillance programs are limited without widely available LGV-specific diagnostics, but LGV prevalence is becoming increasingly recognized as it spreads globally. The LGV epidemic remains high among MSM living with HIV and is now shifting to include more HIV-negative MSM. LGV testing of asymptomatic persons at high risk will increase case finding and potential for earlier intervention. Doxycycline remains the guideline-directed treatment of choice, but recent data may support shorter duration or even use of azithromycin as alternatives. Summary While the burden of LGV is appreciated as a significant cause of proctitis, especially among MSM living with HIV, lack of accessible diagnostics limits our understanding of actual incidence and its impact on the HIV epidemic. Future directions should include assay validation for widespread use and rigorous clinical trials to examine treatment durations based on symptom burden.