A rare sexually transmitted infection (STI) that has beleaguered the developing world is moving to western Europe, say experts.
Outbreaks have occurred in large cities such as Rotterdam in the Netherlands and, more recently, in Antwerp and Paris.
Stockholm, Hamburg and London have also been hit.
Two US men in New York have just been diagnosed with the disease, called lymphomagranuloma venereum (LGV).
"What we are seeing now is something that is quite new and is affecting gay men"
LGV is caused by a strain of bacteria similar to the one that causes another STI called chlamydia.
LGV can affect both men and women, but the current outbreaks have been seen in men who have sex with other men.
Individuals contract LGV through unprotected sex with infected partners.
"LGV was previously hardly ever seen in the Western world," said Neil Macdonald from England's Health Protection Agency (HPA).
"It is endemic in certain areas of Africa, Asia, South America and the Caribbean.
"What we are seeing now is something that is quite new and is affecting gay men."
He said it was not clear how long LGV had been in western Europe and that it might be the case that now people are checking for it more cases are being found.
Symptoms of LGV
Since the HPA set up an enhanced surveillance system for LGV in October, there have been 24 confirmed cases in England.
The HPA has been able to trace 19 of the men. All are homosexual and 17 are also HIV positive.
"We know it's here and we know it is a problem," Mr Macdonald said.
"One of the biggest problems we have is that it doesn't present like a typical STI so not only the patients themselves but also their doctors may not realise they have got it."
'Get checked'
The first symptom of LGV is usually inflammation of the rectum (proctitis), with pain, discharge, rectal bleeding and bloody stools commonly reported, as well as genital ulcers.
The person might also notice large painful swelling in the groin because the infection invades the lymph nodes.
"People need to be aware of the symptoms"
But if it is not detected and treated, complications can develop such as fever, weight loss and lesions and permanent scarring of the rectal lining that might need surgical repair.
In some cases, the symptoms can be mistaken for a bowel problem which can delay the diagnosis, Mr Macdonald said.
He urged anyone who thought they might have put themselves at risk of LGV or any other STI to go to their doctor for a check-up.
Will Mutland from the Terrence Higgins Trust said: "We are working with key target groups of HIV men to raise awareness about LGV."
He said as well as having unprotected sex with multiple partners, this group might be particularly at risk because of they have a condition that affects the immune system and ability to fight infections.
"People need to be aware of the symptoms," he said.
"We also want to encourage regular screening, not just for LGV but for a range of other STIs."
The Terrence Higgins Trust has produced an information leaflet for gay men explaining the risks of LGV.
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