Cole MJ, et al. - In three European countries without existing systems, lymphogranuloma venereum (LGV) surveillance was created and piloted to conduct a initial examination of LGV epidemiology, as little evidence exists currently. In Austria, Croatia and Slovenia, STI or dermatovenereology clinics and related laboratories serving men who have sex with men (MSM) were recruited using the UK for comparison. Chlamydia trachomatis (CT)-positive rectal swabs collected from MSM attending these clinics between October 2016 and May 2017 were examined via centralized LGV testing. They also tested stored specimens from Austria (2015–2016) and Croatia (2014). They tested in total, 500 specimens from CT-positive MSM. LGV positivity was noted in 25.6% overall, in 47.6% from Austria, 20.0% from Croatia, 16.7% from Slovenia and 14.4% from the UK. The findings suggest that, across Europe, underdiagnosis of LGV in MSM is substantial. They emphasize the necessity for unified efforts to overcome barriers to testing, establish effective surveillance, and optimize diagnosis, treatment, and prevention.