*1.2.11 L serovars*

In European and North American MSM, particularly those living with HIV, lymphogranuloma venereum (LGV) has been reported to be caused by *C. trachomatis* L1, L2, and L3 serovars [30]. Symptoms occur in most cases. It has been reported in case studies that anorectal pain, discharge, tenesmus, rectal bleeding, and constipation are among the symptoms reported. It is also possible to experience systemic symptoms such as fever and malaise as well as local symptoms. Several anatomic findings can be observed under anesthesia, including mucopurulent exudate, internal lesions, masses, or polyps. As a result of this presentation, it is sometimes mistaken for an inflammatory bowel disease [31]. Rectal infections caused by the L1, L2, and L3 serovars can result in fistulas and strictures if left untreated [32].

#### *1.2.12 D through K serovars*

In addition to causing genital infection in MSM, these non-LGV serovars are also capable of causing rectum infection. This infection, however, is usually asymptomatic, unlike LGV. For example, according to a study of MSM screened for rectal chlamydial infection, only 16% (49 of 301 cases) of non-LGV infections were symptomatic compared to 95% (58 of 62 cases) of rectal LGV infections [32, 33].

Infected females with rectal C trachomatis usually have D through K serovars and are generally asymptomatic. It is also possible for females to develop symptomatic proctitis [33], but this occurs less frequently than in MSM.
