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1
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Lv L, Liu G, Xu J, Luo J, Peng L, Ding Y, Shi W. Syphilitic proctitis: review of the literature. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2025; 117:233-234. [PMID: 38469807 DOI: 10.17235/reed.2024.10334/2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Syphilitic proctitis is a rare sexually transmitted disease caused by spirochete pallidum infecting the rectal mucosa. It usually has no specific clinical manifestations and is easily misdiagnosed with other rectal and anal diseases such as rectal cancer, malignant lymphoma, inflammatory bowel disease, etc.. Therefore, diagnosis of the disease is difficult and treatment options are often unreasonable. A case of syphilitic proctitis in our hospital with "rectal mass" as the main manifestation is reported as follows and relevant literature is reviewed. At the same time, we studied and analyzed the clinical and histological characteristics and differential diagnosis of syphilitic proctitis to further deepen the understanding of this disease.
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Affiliation(s)
- Liyuan Lv
- Gastroenterology, The Seventh Affiliated Hospital Sun Yat-sen University,
| | - Guinan Liu
- Gastroenterology, The Seventh Affiliated Hospital Sun Yat-sen University
| | - Jie Xu
- Pathological Diagnostic Center, The Seventh Affiliated Hospital Sun Yat-sen University
| | - Juncheng Luo
- Neurology, The Seventh Affiliated Hospital Sun Yat-sen University
| | - Ling Peng
- Neurology, The Seventh Affiliated Hospital Sun Yat-sen University
| | - Yiwei Ding
- Clinical Laboratory, The Seventh Affiliated Hospital Sun Yat-sen University
| | - Weiwen Shi
- Gastroenterology, The Seventh Affiliated Hospital Sun Yat-sen University
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2
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Moliya P, Singh A, Singh N, Kumar V, Sohal A. Insights into gastrointestinal manifestation of human immunodeficiency virus: A narrative review. World J Virol 2025; 14:99249. [PMID: 40134843 PMCID: PMC11612874 DOI: 10.5501/wjv.v14.i1.99249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 10/15/2024] [Accepted: 11/04/2024] [Indexed: 11/28/2024] Open
Abstract
Human immunodeficiency virus (HIV) modifies CD4-positive cells, resulting in immunodeficiency and a wide range of gastrointestinal (GI) manifestations. The burden of HIV-related GI illnesses has significantly evolved with the widespread use of antiretroviral therapy (ART). While ART has effectively reduced the occurrence of opportunistic infections, it has led to an increase in therapy-related GI illnesses. Common esophageal conditions in HIV patients include gastroesophageal reflux disease, idiopathic esophageal ulcers, herpes simplex virus, cytomegalovirus (CMV), and candidal esophagitis. Kaposi's sarcoma, a hallmark of acquired immunodeficiency syndrome, may affect the entire GI system. Gastritis and peptic ulcer disease are also frequently seen in patients with HIV. Diarrhea, often linked to both opportunistic infections and ART, requires careful evaluation. Bloody diarrhea, often a sign of colitis caused by bacterial infections such as Shigella or Clostridium difficile, is prevalent. Small bowel lymphoma, although rare, is increasing in prevalence. Anorectal disorders, including proctitis, fissures, and anal squamous cell carcinoma, are particularly relevant in homosexual men, underlining the importance of timely diagnosis. This review comprehensively explores the epidemiology, pathogenesis, and treatment considerations for the various GI disorders associated with HIV, highlighting the importance of accurate diagnosis and effective treatment to improve outcomes for HIV-infected patients.
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Affiliation(s)
- Pratiksha Moliya
- Department of Transplant Hepatology, University of Nebraska Medical Center, Omaha, NE 69198, United States
| | - Anmol Singh
- Department of Medicine, Tristar Centennial Medical Center, Nashville, TN 37203, United States
| | - Navdeep Singh
- Department of Medicine, Government Medical College, Amritsar 143001, Punjab, India
| | - Vikash Kumar
- Department of Gastroenterology and Hepatology, Creighton University School of Medicine, Phoenix, AZ 85012, United States
| | - Aalam Sohal
- Department of Gastroenterology and Hepatology, Creighton University School of Medicine, Phoenix, AZ 85012, United States
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3
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Patel R, Green J, Moran B, Clarke E, Seneviratne K, Evans C, Young F, Nicholson M, Pelosi E, Kingston M, Foley E. British Association of Sexual Health and HIV UK national guideline for the management of anogenital herpes, 2024. Int J STD AIDS 2025; 36:90-105. [PMID: 39374063 PMCID: PMC11773994 DOI: 10.1177/09564624241282396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Accepted: 08/14/2024] [Indexed: 10/08/2024]
Abstract
The guideline provides recommendations on the management of adults with anogenital herpes in the UK. Recommendations include diagnostic tests, management of the primary or first episode of anogenital herpes and recurrences, effectiveness of therapy, prophylaxis, and prevention of transmission between partners, as well as patient centred counselling.
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Affiliation(s)
- Raj Patel
- Royal South Hants Hospital, Southampton, UK
| | - John Green
- Smith and Rowcroft Draughting Ltd, St Mary’s Hospital, London, UK
| | | | - Emily Clarke
- Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | | | - Ceri Evans
- Chelsea and Westminster Hospital, London, UK
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Hall R, Patel K, Poullis A, Pollok R, Honap S. Separating Infectious Proctitis from Inflammatory Bowel Disease-A Common Clinical Conundrum. Microorganisms 2024; 12:2395. [PMID: 39770599 PMCID: PMC11678827 DOI: 10.3390/microorganisms12122395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Revised: 11/19/2024] [Accepted: 11/20/2024] [Indexed: 01/11/2025] Open
Abstract
Proctitis refers to inflammation in the rectum and may result in rectal bleeding, discharge, urgency, tenesmus, and lower abdominal pain. It is a common presentation, particularly in genitourinary medicine and gastroenterology, as the two most common causes are sexually transmitted infections and inflammatory bowel disease. The incidence of infective proctitis is rising, particularly amongst high-risk groups, including men who have sex with men, those with HIV seropositive status, and those participating in high-risk sexual behaviours. The most commonly isolated organisms are Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema palladium, herpes simplex virus, and Mycoplasma genitalium. Recently, proctitis was also identified as a common feature during the Mpox outbreak. Distinguishing infective proctitis from inflammatory bowel disease remains a significant clinical challenge as there is significant overlap in the clinical presentation and their endoscopic and histological features. This review compares and highlights the distinguishing hallmarks of both inflammatory and infective causes of proctitis. It provides a practical guide to describe the key features that clinicians should focus on in both clinical and key diagnostic investigations to avoid potential misdiagnosis.
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Affiliation(s)
- Richard Hall
- Department of Gastroenterology, St George’s University Hospital, London SW17 0QT, UK; (R.H.)
| | - Kamal Patel
- Department of Gastroenterology, St George’s University Hospital, London SW17 0QT, UK; (R.H.)
| | - Andrew Poullis
- Department of Gastroenterology, St George’s University Hospital, London SW17 0QT, UK; (R.H.)
| | - Richard Pollok
- Department of Gastroenterology, St George’s University Hospital, London SW17 0QT, UK; (R.H.)
- Institute of Infection and Immunity, St George’s University, London SW17 0RE, UK
| | - Sailish Honap
- Department of Gastroenterology, St George’s University Hospital, London SW17 0QT, UK; (R.H.)
- School of Immunology and Microbial Sciences, King’s College London, London SE1 9NH, UK
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5
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Cantu Lopez C, Herrera-Gonzalez S, Shamoon D, Dacosta TJ, Bains Y. The Great Mimicker Gets Caught: A Rare Case of Syphilis in the Gastrointestinal Tract. Cureus 2024; 16:e59222. [PMID: 38807842 PMCID: PMC11132664 DOI: 10.7759/cureus.59222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 05/30/2024] Open
Abstract
Syphilis is a sexually transmitted disease that impacts multiple organ systems and can mimic various diseases and is an extremely rare cause of proctitis in men who have sex with men and transgender females. We present a case of a 49-year-old transgender female with a medical history significant for diabetes mellitus and hyperlipidemia who presented to the emergency department with dull abdominal pain in the left upper and lower quadrants for two days. She had non-bloody, nonbilious emesis, 10-pound weight loss over 1 month, and constipation for 2 weeks. Laboratory results showed a cholestatic pattern. Computed tomography of the abdomen showed rectal wall thickening, multiple enlarged perirectal adenopathy, and mild inflammatory infiltration around the rectum suggesting superimposed proctitis. On colonoscopy, a possible rectal mass or severe proctitis with near complete obstruction was seen with initial pathology concerning for lymphoma or a rare type of colitis. The patient was empirically started on ceftriaxone and doxycycline leading to improvement in inflammation. Special stains requested were positive for Treponema pallidum confirming the diagnosis of syphilitic proctitis and highly suggestive syphilitic hepatitis. Few cases of syphilitic proctitis imitating rectal malignancy and syphilitic hepatitis have been reported. Syphilis requires exclusion as well as confirmation of spirochetes for high-risk populations with special staining. It is important to diagnose syphilis in special populations that are at high risk of contraction.
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Affiliation(s)
| | | | - Dema Shamoon
- Gastroenterology and Hepatology, Saint Michael's Medical Center, Newark, USA
| | - Theodore Jr Dacosta
- Gastroenterology and Hepatology, Saint Michael's Medical Center, Newark, USA
| | - Yatinder Bains
- Gastroenterology and Hepatology, Saint Michael's Medical Center, Newark, USA
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6
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McNeil CJ, Barroso LF, Workowski K. Proctitis: An Approach to the Symptomatic Patient. Med Clin North Am 2024; 108:339-354. [PMID: 38331484 DOI: 10.1016/j.mcna.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Proctitis is an inflammatory condition of the distal rectum that can be associated with common sexually transmitted infections (STIs), such as gonorrhea, chlamydia, and syphilis. For persons presenting with ulcerative findings on examination, in addition to syphilis, Mpox, lymphogranuloma venereum, and herpes simplex virus should be in the differential. Providers should also be aware that there are evolving data to support a role for Mycoplasma genitalium in proctitis. Performing a comprehensive history, clinical evaluation including anoscopy, and rectal nucleic amplification STI testing may be useful in identifying the cause of proctitis and targeting treatment.
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Affiliation(s)
- Candice J McNeil
- Department of Medicine, Section on Infectious Diseases, Wake Forest University School of Medicine.
| | - Luis F Barroso
- Department of Medicine, Section on Infectious Diseases, Wake Forest University School of Medicine
| | - Kimberly Workowski
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine
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Paulus-Andres JA, Lavery MM. Acute Infectious Proctitis Caused by Anorectal Sexually Transmitted Infections. Dis Colon Rectum 2023; 66:1157-1159. [PMID: 37339280 DOI: 10.1097/dcr.0000000000002979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Affiliation(s)
- Jordan A Paulus-Andres
- Department of Colon and Rectal Surgery, Swedish Medical Center, Swedish Medical Center First Hill Campus, Seattle, Washington
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8
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Strobel TM, Desai NA, Arrington-Sanders R. Acute Infectious Proctitis in Adolescents. Pediatr Rev 2023; 44:491-497. [PMID: 37653133 DOI: 10.1542/pir.2022-005862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
The diagnosis of acute proctitis requires understanding who is at risk, being aware of symptoms, and leveraging a thorough sexual history with appropriate risk stratification to make the diagnosis. Cases have been concentrated in adolescents (ages 15-19 years), young adults (ages 20-24 years), men and transgender women who have sex with men, and those with a history of human immunodeficiency virus infection. Black adolescents experience a disproportionately high number of cases of proctitis due to an intersection of concentrated cases in sexual networks and delayed screening/diagnosis due to health care access barriers. Signs and symptoms include purulent discharge, bleeding, pain, tenesmus, pruritus, diarrhea or constipation, weight loss, or fever. Multisite sexually transmitted infection testing should be offered based on risk stratification (eg, history of condomless anal sex, oral intercourse, number of sex partners). Further management includes promotion of barrier protection and preexposure prophylaxis, routine surveillance, partner notification, and routine access to preventive immunizations.
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Affiliation(s)
| | - Neerav A Desai
- Division of Adolescent and Young Adult Health, Vanderbilt University Medical Center, Nashville, TN
| | - Renata Arrington-Sanders
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, MD
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9
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Richardson D, Pakianathan M, Ewens M, Mitchell H, Mohammed H, Wiseman E, Tweed M, Nichols K, Rawdah W, Cooper R, Macrowan R, Irish M, Evans A, Godbole G. British Association of Sexual Health and HIV (BASHH) United Kingdom national guideline for the management of sexually transmitted enteric infections 2023. Int J STD AIDS 2023:9564624231168217. [PMID: 37247427 DOI: 10.1177/09564624231168217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This is the first British Association of Sexual Health and HIV (BASHH) national guideline for the management of sexually transmitted enteric infections (STEI). This guideline is primarily aimed for level 3 sexual health clinics; however, it may also be applicable to other settings such as primary care or other hospital departments where individuals with STEI may present. This guideline makes recommendations on testing, management, partner notification and public health control of STEI.
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Affiliation(s)
- Daniel Richardson
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Brighton & Sussex Medical School, Brighton, UK
| | | | | | | | | | | | | | | | - Waseem Rawdah
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Richard Cooper
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | | | - Amy Evans
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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10
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Singh R, Gantz O, HeHolt J, Dubey A. CT findings of proctitis in two patients with Mpox. Emerg Radiol 2023; 30:387-389. [PMID: 37162597 DOI: 10.1007/s10140-023-02140-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/26/2023] [Indexed: 05/11/2023]
Abstract
Mpox (formerly known as Monkeypox) has emerged as a public health crisis in 2022 with recent global spread outside of endemic regions and secondary transmission of this zoonotic disease between humans. The current outbreak predominantly affects men who have sex with men (MSM). Classically, Mpox presents with fever, rash, and lymphadenopathy; however, in the MSM population, genital/perianal skin lesions and rectal pain due to proctitis are commonly present. We present the CT findings of active proctitis in two cases of Mpox infection.
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Affiliation(s)
- Rohindeep Singh
- SUNY Downstate Health Sciences University, 445 Lenox Road, Brooklyn, NY, 11203, USA.
| | - Owen Gantz
- SUNY Downstate Health Sciences University, 445 Lenox Road, Brooklyn, NY, 11203, USA
| | - Justin HeHolt
- SUNY Downstate Health Sciences University, 445 Lenox Road, Brooklyn, NY, 11203, USA
| | - Anju Dubey
- SUNY Downstate Health Sciences University, 445 Lenox Road, Brooklyn, NY, 11203, USA
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11
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Griemert T, Siegel E, Brandstetter M, Straub BK, Kreft A, Galle PR, Sprinzl MF. Entamoeba histolytica-associated proctitis and ileitis mimicking Crohn's disease-A case report. Clin Case Rep 2023; 11:e6833. [PMID: 37220511 PMCID: PMC10199808 DOI: 10.1002/ccr3.6833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/28/2022] [Accepted: 12/05/2022] [Indexed: 05/25/2023] Open
Abstract
We report about a proctitis and ileitis terminalis, leading to the misdiagnosis of Chron's disease, in a male patient who has sex with men. Molecular multiplex analysis identified Entamoeba histolytica as the underlying cause. We provide diagnostic images, clues and pitfalls for diagnosis of E. histolytica associated proctitis.
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Affiliation(s)
- Thomas Griemert
- Department of Internal Medicine IUniversity Medical Center of the Johannes Gutenberg UniversityMainzGermany
| | - Ekkehard Siegel
- Institute of MicrobiologyUniversity Medical Center of the Johannes Gutenberg UniversityMainzGermany
| | - Moritz Brandstetter
- Institute of MicrobiologyUniversity Medical Center of the Johannes Gutenberg UniversityMainzGermany
| | - Beate K. Straub
- Institute of PathologyUniversity Medical Center of the Johannes Gutenberg UniversityMainzGermany
| | - Andreas Kreft
- Institute of PathologyUniversity Medical Center of the Johannes Gutenberg UniversityMainzGermany
| | - Peter R. Galle
- Department of Internal Medicine IUniversity Medical Center of the Johannes Gutenberg UniversityMainzGermany
| | - Martin F. Sprinzl
- Department of Internal Medicine IUniversity Medical Center of the Johannes Gutenberg UniversityMainzGermany
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Kumbhakar R, Barbee LA, Berzkalns A, Herrmann S, Ramchandani MS, Golden MR, Dombrowski JC. Etiologies of Proctitis at a Sexual Health Clinic in Seattle, Washington From 2011 to 2021. Sex Transm Dis 2022; 49:860-862. [PMID: 35969837 PMCID: PMC10538061 DOI: 10.1097/olq.0000000000001696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT We analyzed microbiologic etiologies of proctitis among patients seen in an urban sexual health clinic during 2011 to 2021. Among 759 cases, 179 (24%) tested positive for Neisseria gonorrhoeae , 171 (23%) for Chlamydia trachomatis , 21 (3%) for herpes simplex virus, 30 (4%) for syphilis, and 73 (10%) for multiple pathogens; no pathogen was identified in 425 (56%).
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Affiliation(s)
- Raaka Kumbhakar
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | - Lindley A. Barbee
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
- Public Health- Seattle & King Country HIV/STD Program, Seattle, Washington
| | - Anna Berzkalns
- Public Health- Seattle & King Country HIV/STD Program, Seattle, Washington
| | - Susannah Herrmann
- Public Health- Seattle & King Country HIV/STD Program, Seattle, Washington
| | - Meena S. Ramchandani
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
- Public Health- Seattle & King Country HIV/STD Program, Seattle, Washington
| | - Matthew R. Golden
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
- Public Health- Seattle & King Country HIV/STD Program, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Julia C. Dombrowski
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
- Public Health- Seattle & King Country HIV/STD Program, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
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Itani M, Kaur N, Roychowdhury A, Mellnick VM, Lubner MG, Dasyam AK, Khanna L, Prasad SR, Katabathina VS. Gastrointestinal Manifestations of Immunodeficiency: Imaging Spectrum. Radiographics 2022; 42:759-777. [PMID: 35452341 DOI: 10.1148/rg.210169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is a wide spectrum of hereditary and acquired immunodeficiency disorders that are characterized by specific abnormalities involving a plethora of humoral, cellular, and phagocytic immunologic pathways. These include distinctive primary immunodeficiency syndromes due to characteristic genetic defects and secondary immunodeficiency syndromes, such as AIDS from HIV infection and therapy-related immunosuppression in patients with cancers or a solid organ or stem cell transplant. The gut mucosa and gut-associated lymphoid tissue (the largest lymphoid organ in the body), along with diverse commensal microbiota, play complex and critical roles in development and modulation of the immune system. Thus, myriad gastrointestinal (GI) symptoms are common in immunocompromised patients and may be due to inflammatory conditions (graft versus host disease, neutropenic enterocolitis, or HIV-related proctocolitis), opportunistic infections (viral, bacterial, fungal, or protozoal), or malignancies (Kaposi sarcoma, lymphoma, posttransplant lymphoproliferative disorder, or anal cancer). GI tract involvement in immunodeficient patients contributes to significant morbidity and mortality. Along with endoscopy and histopathologic evaluation, imaging plays an integral role in detection, localization, characterization, and distinction of GI tract manifestations of various immunodeficiency syndromes and their complications. Select disorders demonstrate characteristic findings at fluoroscopy, CT, US, and MRI that permit timely and accurate diagnosis. While neutropenic enterocolitis affects the terminal ileum and right colon and occurs in patients receiving chemotherapy for hematologic malignancies, Kaposi sarcoma commonly manifests as bull's-eye lesions in the stomach and duodenum. Imaging is invaluable in treatment follow-up and long-term surveillance as well. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Malak Itani
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., V.M.M.); Department of Radiology, University of Louisville, Louisville, Ky (N.K.); Department of Radiology, VA Medical Center, Fayetteville, NC (A.R.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.); Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., V.S.K.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Neeraj Kaur
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., V.M.M.); Department of Radiology, University of Louisville, Louisville, Ky (N.K.); Department of Radiology, VA Medical Center, Fayetteville, NC (A.R.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.); Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., V.S.K.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Abhijit Roychowdhury
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., V.M.M.); Department of Radiology, University of Louisville, Louisville, Ky (N.K.); Department of Radiology, VA Medical Center, Fayetteville, NC (A.R.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.); Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., V.S.K.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Vincent M Mellnick
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., V.M.M.); Department of Radiology, University of Louisville, Louisville, Ky (N.K.); Department of Radiology, VA Medical Center, Fayetteville, NC (A.R.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.); Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., V.S.K.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Meghan G Lubner
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., V.M.M.); Department of Radiology, University of Louisville, Louisville, Ky (N.K.); Department of Radiology, VA Medical Center, Fayetteville, NC (A.R.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.); Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., V.S.K.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Anil K Dasyam
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., V.M.M.); Department of Radiology, University of Louisville, Louisville, Ky (N.K.); Department of Radiology, VA Medical Center, Fayetteville, NC (A.R.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.); Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., V.S.K.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Lokesh Khanna
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., V.M.M.); Department of Radiology, University of Louisville, Louisville, Ky (N.K.); Department of Radiology, VA Medical Center, Fayetteville, NC (A.R.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.); Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., V.S.K.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Srinivasa R Prasad
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., V.M.M.); Department of Radiology, University of Louisville, Louisville, Ky (N.K.); Department of Radiology, VA Medical Center, Fayetteville, NC (A.R.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.); Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., V.S.K.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Venkata S Katabathina
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., V.M.M.); Department of Radiology, University of Louisville, Louisville, Ky (N.K.); Department of Radiology, VA Medical Center, Fayetteville, NC (A.R.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.); Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., V.S.K.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
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14
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Chow EPF, Lee D, Bond S, Fairley CK, Maddaford K, Wigan R, Fehler G, Lange SA, De Petra V, Bissessor M, Bradshaw CS, Howden BP, Hocking JS, Williamson DA, Chen MY. Nonclassical Pathogens as Causative Agents of Proctitis in Men who Have Sex With Men. Open Forum Infect Dis 2021; 8:ofab137. [PMID: 34671693 PMCID: PMC8521645 DOI: 10.1093/ofid/ofab137] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to identify enteric and sexually acquired rectal pathogens,
other than chlamydia and gonorrhea, associated with symptomatic proctitis in
men who have sex with men (MSM). Methods Anorectal swab samples were obtained from MSM presenting with rectal symptoms
and a clinical diagnosis of proctitis at the Melbourne Sexual Health Centre
between January 2017 and March 2019. Samples that tested positive for
Neisseria gonorrhoeae and Chlamydia
trachomatis were excluded. As a comparison group, anorectal
samples were also obtained from MSM not reporting symptoms of proctitis
between November 2018 and February 2019. Samples from both groups were
tested for 15 viral, bacterial, and protozoal enteric pathogens using
polymerase chain reaction. Results Anorectal samples from 499 men with symptomatic proctitis and 506
asymptomatic men were analyzed. Age, HIV status, and pre-exposure
prophylaxis (PrEP) use did not differ between men with proctitis and
asymptomatic men. Treponema pallidum was more common in men
with proctitis (risk difference [RD], 3.6%; 95% CI, 2.0%–5.2%). Most
men with anorectal T. pallidum presented with painful anal
primary infections. Shigella spp. was more common among men
with proctitis compared with asymptomatic men (RD, 1.8%; 95% CI,
0.1%–3.5%). Most men with Shigella did not report
diarrhea. Mycoplasma genitalium was more common in men with
proctitis (RD, 4.3%; 95% CI, 1.1%–7.5%). Herpes simplex virus
(HSV)–1 (RD, 10.1%; 95% CI, 6.8%–13.3%) and HSV-2 (RD, 7.2%; 95%
CI, 4.5%–10.0%) were more common with proctitis. Conclusions Testing for T. pallidum, Shigella, and HSV
should be considered in MSM presenting with symptomatic proctitis. These
data provide support for M. genitalium as a significant
cause of proctitis. A comprehensive diagnostic evaluation is required for
MSM with proctitis.
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Affiliation(s)
- Eric P F Chow
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Darren Lee
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity at The University of Melbourne, Melbourne, Victoria, Australia
| | - Stephanie Bond
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Kate Maddaford
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Rebecca Wigan
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Glenda Fehler
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Sigrid A Lange
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity at The University of Melbourne, Melbourne, Victoria, Australia
| | - Vesna De Petra
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity at The University of Melbourne, Melbourne, Victoria, Australia
| | - Melanie Bissessor
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Catriona S Bradshaw
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity at The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Deborah A Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity at The University of Melbourne, Melbourne, Victoria, Australia.,Department of Microbiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Marcus Y Chen
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
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15
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Mascarenhas Saraiva M, Ribeiro TF, Macedo G. Infectious Proctitis in Ulcerative Colitis: The Importance of an Accurate Differential Diagnosis. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 28:354-359. [PMID: 34604467 DOI: 10.1159/000510784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/07/2020] [Indexed: 11/19/2022]
Abstract
The authors present the case of a 62-year-old male presenting with a relapse of ulcerative colitis. He had unprotected anal intercourse with other men and his medical record was remarkable for HIV infection. He was admitted to the emergency department with bloody diarrhea, tenesmus, urgency, and recent weight loss. Laboratory workup revealed de novo mild anemia and mild elevation of inflammation parameters. Endoscopic evaluation displayed loss of normal vascular pattern, edema, erythema, exudation, and superficial ulceration in the distal rectum. Biopsies showed chronic proctitis with mild to moderate activity. The patient was treated with intravenous glucocorticoids, but symptoms persisted. Extensive microbial study allowed the identification of multiple infectious agents with potential for infectious proctitis: cytomegalovirus, Chlamydia trachomatis, and Blastocystis hominis. This case highlights the importance of careful microbial investigation, supporting a detailed clinical history, in patients presenting with symptoms of inflammatory bowel disease flare, particularly in risk groups such as that with sexual risk.
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Affiliation(s)
| | - Tiago Filipe Ribeiro
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
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16
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Abstract
Gonorrhea and chlamydia rates have risen to record-high levels in the United States over the past decade. Because these infections are often asymptomatic, effective clinical management relies on screening of asymptomatic patients, particularly women younger than 25 years and men who have sex with men. If undetected and untreated, gonorrhea and chlamydia can lead to infertility, ectopic pregnancy, and chronic pelvic pain and can facilitate HIV acquisition and transmission. Primary care providers need to be aware of recent changes in recommended treatments for both infections.
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Affiliation(s)
- Julia C Dombrowski
- University of Washington and Public Health - Seattle & King County, Seattle, Washington (J.C.D.)
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17
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Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1-187. [PMID: 34292926 PMCID: PMC8344968 DOI: 10.15585/mmwr.rr7004a1] [Citation(s) in RCA: 1044] [Impact Index Per Article: 261.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11-14, 2019. The information in this report updates the 2015 guidelines. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus. Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs.
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18
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Craviotto V, Furfaro F, Loy L, Zilli A, Peyrin-Biroulet L, Fiorino G, Danese S, Allocca M. Viral infections in inflammatory bowel disease: Tips and tricks for correct management. World J Gastroenterol 2021; 27:4276-4297. [PMID: 34366605 PMCID: PMC8316900 DOI: 10.3748/wjg.v27.i27.4276] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/01/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
Over the past decades, the treatment of inflammatory bowel diseases (IBD) has become more targeted, anticipating the use of immune-modifying therapies at an earlier stage. This top-down approach has been correlated with favorable short and long-term outcomes, but it has also brought with it concerns regarding potential infectious complications. This large IBD population treated with immune-modifying therapies, especially if combined, has an increased risk of severe infections, including opportunistic infections that are sustained by viral, bacterial, parasitic, and fungal agents. Viral infections have emerged as a focal safety concern in patients with IBD, representing a challenge for the clinician: they are often difficult to diagnose and are associated with significant morbidity and mortality. The first step is to improve effective preventive strategies, such as applying vaccination protocols, adopt adequate prophylaxis and educate patients about potential risk factors. Since viral infections in immunosuppressed patients may present atypical signs and symptoms, the challenges for the gastroenterologist are to suspect, recognize and diagnose such complications. Appropriate treatment of common viral infections allows us to minimize their impact on disease outcomes and patients’ lives. This practical review supports this standard of care to improve knowledge in this subject area.
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Affiliation(s)
- Vincenzo Craviotto
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
| | - Federica Furfaro
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
| | - Laura Loy
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
| | - Alessandra Zilli
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
| | - Laurent Peyrin-Biroulet
- Department of Hepato-Gastroenterology and Inserm U954, University Hospital of Nancy, Lorraine University, Nancy 54511, France
| | - Gionata Fiorino
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milano, Italy
| | - Silvio Danese
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milano, Italy
| | - Mariangela Allocca
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milano, Italy
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19
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Costales-Cantrell JK, Dong EY, Wu BU, Nomura JH. Syphilitic Proctitis Presenting as a Rectal Mass: a Case Report and Review of the Literature. J Gen Intern Med 2021; 36:1098-1101. [PMID: 33469766 PMCID: PMC8042098 DOI: 10.1007/s11606-020-06414-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 12/08/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Jessica K Costales-Cantrell
- Division of Infectious Diseases, University of California Irvine Medical Center, 101 City Drive South, City Tower Suite 400, Orange, CA, 92868, USA.
| | - Elizabeth Y Dong
- Department of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Bechien U Wu
- Department of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Jim H Nomura
- Division of Infectious Diseases, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
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20
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Newman KL, Newman GS, Cybulski RJ, Fang FC. Gastroenteritis in Men Who Have Sex With Men in Seattle, Washington, 2017-2018. Clin Infect Dis 2021; 71:109-115. [PMID: 31621824 DOI: 10.1093/cid/ciz783] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 08/09/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are at risk for sexual transmission of enteric pathogens. The microbiology of gastroenteritis in MSM has not been examined since the advent of antiretroviral therapy and molecular diagnostics. Our objective was to assess the causes of gastroenteritis among MSM living with and without human immunodeficiency virus (HIV) coinfection in Seattle, Washington. METHODS We conducted a retrospective cohort study of 235 MSM who underwent multiplex stool polymerase chain reaction (PCR) testing between 1 January 2017 and 1 June 2018. We abstracted clinical and laboratory data from electronic medical records. Parallel or reflexive culture and susceptibility testing were performed when PCR detected cultivable pathogens. RESULTS Among 235 MSM tested (268 episodes), 131 had 151 episodes with positive test results. 148 (63.0%) individuals were living with HIV. Among positive tests, 88.7% detected a bacterial pathogen, 26% a virus, and 40% a parasite. Diarrheagenic Escherichia coli (enteroaggretative, enteropathogenic), Shigella, and Campylobacter were the most commonly detected bacteria (33.1%, 30.5%, and 17.2% of positive samples, respectively). Forty-three percent of positive specimens had ≥2 pathogens. Etiologies and clinical presentations were similar between men living with and without HIV. Cultured Shigella and Campylobacter isolates were frequently resistant to multiple antibiotics. CONCLUSIONS MSM present with gastroenteritis from varied pathogens, including some not detected by conventional stool culture. High levels of antibiotic resistance are consistent with frequent antibiotic exposure in this population and the transmission of multiresistant strains. New approaches are needed to detect, treat, and prevent enteric infections in MSM.
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Affiliation(s)
- Kira L Newman
- Department of Medicine, University of Washington School of Medicine, Seattle, USA
| | | | - Robert J Cybulski
- Department of Pathology and Area Laboratory Services, Brooke Army Medical Center, San Antonio, Texas, USA
| | - Ferric C Fang
- Department of Medicine, University of Washington School of Medicine, Seattle, USA.,Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, USA.,Department of Microbiology, University of Washington School of Medicine, Seattle, USA
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21
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Hughes Y, Lewis DA. HSV-associated proctitis presenting without perianal lesions: why testing and empirical treatment may be important. BMJ Case Rep 2021; 14:14/1/e237247. [PMID: 33431534 PMCID: PMC7802666 DOI: 10.1136/bcr-2020-237247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
A man in his late 30s presented with a several-day history of rectal pain, discharge and bleeding associated with systemic upset. Sexual history revealed receptive anal sex with several male partners in the 2 weeks preceding his clinic visit. Examination of the perianal area was unremarkable. Proctoscopy showed evidence of non-ulcerative proctitis. Microscopy for Gram stain showed pus cells plus extracellular Gram-negative diplococci. The patient was treated for presumptive gonorrhoea and chlamydial infection with ceftriaxone, azithromycin and doxycycline. The patient failed to improve with this treatment regimen. Rectal swab results at 48 hours confirmed the causative agent to be herpes simplex virus (HSV) type 2. The patient was recalled and treated successfully with valaciclovir. This case serves as a useful reminder to clinicians to consider HSV in the differential diagnosis of sexually transmitted proctitis, in the absence of perianal or anorectal ulceration.
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Affiliation(s)
- Yasmin Hughes
- Western Sydney Sexual Health Centre, Parramatta, NSW, Australia
| | - David A Lewis
- Western Sydney Sexual Health Centre, Parramatta, NSW, Australia,Marie Bashir Institute for Infectious Diseases and Biosecurity & Westmead Clinical School, Faculty of Medicine & Health, University of Sydney, Westmead, NSW, Australia
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22
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Rizza S, Mistrangelo M, Ribaldone DG, Morino M, Astegiano M, Saracco GM, Pellicano R. Proctitis: a glance beyond inflammatory bowel diseases. MINERVA GASTROENTERO 2020; 66:252-266. [PMID: 32218425 DOI: 10.23736/s1121-421x.20.02670-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Proctitis is an inflammation involving the anus and the distal part of the rectum, frequently diagnosed in the context of inflammatory bowel diseases (IBD). Nevertheless, when the standard therapy for IBD is ineffective, it becomes necessary for the clinician to review alternative etiologies, beginning from the broad chapter of infectious causes up to rare causes such as radiation, ischemia, diversion and traumatisms. While it is possible to find infectious proctitides caused by pathogens generally inducing extensive colitis, the growing incidence of both sexually transmitted infections and isolated proctitis reported in the recent years require a lot of attention. The risk appears to be higher in individuals participating in anal intercourse, especially men having sex with men (MSM) or subjects who use sex toys and participate to sex parties, dark rooms and so on. The commonest implicated pathogens are Neysseria gonorrhoeae, Chlamydia trachomatis, Herpes Simplex virus and Treponema pallidum. Herpes and Chlamydia infections mainly occur in HIV-positive MSM patients. Since symptoms and signs are common independently from etiology, performing a differential diagnosis based on clinical manifestations is complicated. Therefore, the diagnosis is supported by the combination of clinical history and physical examination and, secondly, by endoscopic, serologic and microbiologic findings. Particular emphasis should be given to simultaneous infections by multiple organisms. The involvement of experts in infectious diseases and in sexual health is crucial for the diagnostic and therapeutic management. The available therapies, empirically initiated or specific, in many cases are able to guarantee a good prognosis and to prevent relapses.
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Affiliation(s)
- Stefano Rizza
- Unit of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Davide G Ribaldone
- Unit of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Mario Morino
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Marco Astegiano
- Unit of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Giorgio M Saracco
- Unit of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy
- Unit of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Rinaldo Pellicano
- Unit of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy -
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23
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Abstract
The incidence of syphilis is increasing. Syphilitic proctitis involving the rectal mucosa often presents with pain on defecation, rectal bleeding, or ulceration. We present a case of asymptomatic syphilitic proctitis diagnosed upon a routine screening colonoscopy.
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24
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Mwasakifwa GE, Nugent C, Varma R. Proctitis in gay and bisexual men. Are microscopy and proctoscopy worthwhile? Sex Transm Infect 2020; 96:475-477. [PMID: 32001659 DOI: 10.1136/sextrans-2019-054197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/15/2019] [Accepted: 01/12/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We explored the association between nucleic acid amplification testing (NAAT) and rectal microscopy/proctoscopy findings and correlates of rectal STIs among 150 gay and bisexual men (GBM) diagnosed with proctitis at the Sydney Sexual Health Centre from March 2016 to October 2017. METHODS From case files, we analysed risk behaviours, microscopy, proctoscopy and NAAT results for rectal STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, herpes simplex virus type 1/2, lymphogranuloma venereum and syphilis). χ2 test assessed the association between microscopy/proctoscopy findings and NAAT results. Linear regression assessed the association between NAAT positivity and correlates of rectal STIs. RESULTS The mean age was 32.5 (9.8) years, 43% (65/150) were taking pre-exposure prophylaxis, 17% (26/150) were HIV positive and 24% (36/147) had multiple rectal STIs.Among GBM with documented proctoscopy findings (n=113), 58% (65/113) had discharge, 36% (41/113) had anorectal erythema and 25% (28/113) had bleeding. A quarter of GBM (28/113) had negative proctoscopy findings.Discharge found on proctoscopy (p=0.001), positive HIV status (p=0.030) and time since last receptive anal intercourse (p=0.028) were independently associated with NAAT positivity for any rectal STI. Discharge had a positive likelihood ratio of 1.6 (95% CI 1.0 to 2.4).Among those with documented microscopy findings (n=69), 59% (41/69) and 41% (28/69) were NAAT positive and negative, respectively. Among NAAT-positive GBM, 27 (66%) had polymorphonuclear cells (PMNs) (mean number of PMNs, 10 (SD 9) cells per oil immersion field), 1 (2%) had Gram-negative intracellular diplococci and 11 (27%) had negative findings. There was no significant association between microscopy findings and NAAT results (p=0.651) or the number of rectal STI (p=0.279). CONCLUSION Microscopy does not reliably provide information necessary to tailor the management of GBM diagnosed with proctitis. Discharge found during proctoscopy may identify GBM with rectal STI. Services should consider recommendations to perform these investigations.
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Affiliation(s)
- Gwamaka Eliudi Mwasakifwa
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia .,Sydney Sexual Health Centre, Sydney, NSW, Australia
| | | | - Rick Varma
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,Sydney Sexual Health Centre, Sydney, NSW, Australia
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25
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A Rare Case of Disseminated Mycobacterium avium-intracellulare Presenting as Proctitis. Case Rep Gastrointest Med 2019; 2019:8129597. [PMID: 31885949 PMCID: PMC6914957 DOI: 10.1155/2019/8129597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/27/2019] [Indexed: 11/25/2022] Open
Abstract
Mycobacterium avium intracellulare (MAI) infections are common in Human Immuno-deficiency Virus (HIV) positive patients. MAI infection can have localized or disseminated presentation, patients with low CD4 count presenting with disseminated infection. Fever, abdominal pain, diarrhea, and weight loss are generally the presenting symptoms of disseminated MAI. We present a rare case of a patient with HIV and low CD4 count presenting with proctitis as manifestation of disseminated MAI infection. A 25 year-old-man with HIV came to the emergency room (ER) with complaints of intermittent rectal bleeding for two months. His CD4 count was less than 20 cells/µL. He was MSM (men having sex with men) and has receptive anal intercourse with men. His stool work-up was unrevealing for infectious etiology. Swabs for gonorrhea and chlamydia were negative. Colonoscopy revealed erythematous, congested, friable rectal mucosa with two superficial ulcers. Biopsies of the ulcer were positive for acid fast staining bacteria and the culture grew MAI. His blood culture was negative for growth of acid-fast bacteria (AFB). However, liver biopsy performed for elevated alkaline phosphatase of 958 units/L revealed noncaseating granuloma. Gastro-duodenoscopy with duodenal biopsy did not reveal any mucosal abnormality. He was managed as with disseminated MAI infection using clarithromycin, ethambutol, and rifabutin in addition to HAART therapy. Interval Colonoscopy in 20 months showed resolution of rectal ulcer. The gut is often involved in patients with disseminated MAI infection, with the duodenum being the most common site. MAI infection should be suspected as possible etiology for proctitis in HIV positive patient with low CD4 count, as proctitis, though infrequent can be the sole presentation for disseminated MAI infection in patients with HIV and low CD4 count.
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26
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Pinto-Sander N, Parkes L, Fitzpatrick C, Richardson D. Symptomatic sexually transmitted proctitis in men who have sex with men. Sex Transm Infect 2019; 95:471. [DOI: 10.1136/sextrans-2018-053936] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/27/2018] [Indexed: 11/04/2022] Open
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27
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Proctitis Caused by Mycobacterium avium-intracellulare in an HIV-Infected Patient. Diseases 2018; 6:diseases6020036. [PMID: 29738438 PMCID: PMC6023385 DOI: 10.3390/diseases6020036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/02/2018] [Accepted: 05/05/2018] [Indexed: 11/17/2022] Open
Abstract
Infectious proctitis is usually associated with sexually transmitted diseases, especially in HIV-infected individuals. Limited information is found about the role of Mycobacterium avium-intracellulare as a causative agent for this condition. Here, we report the case of an HIV-infected patient with a CD4 count of 304 cells/uL and undetectable HIV viral load, who presented with constipation and painful defecation. Endoscopic evaluation was significant for shallow rectal ulcerations. Histopathology revealed poorly formed granulomas. Stool culture grew Mycobacterium sp. that was further identified as Mycobacterium avium-intracellulare by DNA probe. He was successfully treated with a 3-drug regimen that included azithromycin, ethambutol and rifabutin. We advocate the use of AFB stool culture in cases of proctitis in which initial investigations for sexually transmitted diseases are unrevealing.
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28
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Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R. Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men. Emerg Infect Dis 2018; 23:542-543. [PMID: 28221124 PMCID: PMC5382739 DOI: 10.3201/eid2303.161039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We report 2 cases from Spain of infectious proctitis caused by Neisseria meningitidis in HIV-positive men who have sex with men. Genetic characterization of the isolates showed that they are unusual strains not found in other more frequent meningococcal locations. This finding suggests an association between specific strains and anogenital tract colonization.
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Clutterbuck D, Asboe D, Barber T, Emerson C, Field N, Gibson S, Hughes G, Jones R, Murchie M, Nori AV, Rayment M, Sullivan A. 2016 United Kingdom national guideline on the sexual health care of men who have sex with men. Int J STD AIDS 2018:956462417746897. [PMID: 29334885 DOI: 10.1177/0956462417746897] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
This guideline is intended for use in UK Genitourinary medicine clinics and sexual health services but is likely to be of relevance in all sexual health settings, including general practice and Contraception and Sexual Health (CASH) services, where men who have sex with men (MSM) seek sexual health care or where addressing the sexual health needs of MSM may have public health benefits. For the purposes of this document, MSM includes all gay, bisexual and all other males who have sex with other males and both cis and trans men. This document does not provide guidance on the treatment of particular conditions where this is covered in other British Association for Sexual Health and HIV (BASHH) Guidelines but outlines best practice in multiple aspects of the sexual health care of MSM. Where prevention of sexually transmitted infections including HIV can be addressed as an integral part of clinical care, this is consistent with the concept of combination prevention and is included. The document is designed primarily to provide guidance on the direct clinical care of MSM but also makes reference to the design and delivery of services with the aim of supporting clinicians and commissioners in providing effective services. Methodology This document was produced in accordance with the guidance set out in the BASHH CEG's document 'Framework for guideline development and assessment' published in 2010 at http://www.bashh.org/guidelines and with reference to the Agree II instrument. Following the production of the updated framework in April 2015, the GRADE system for assessing evidence was adopted and the draft recommendations were regraded. Search strategy (see also Appendix 1) Ovid Medline 1946 to December 2014, Medline daily update, Embase 1974 to December 2014, Pubmed NeLH Guidelines Database, Cochrane library from 2000 to December 2014. Search language English only. The search for Section 3 was conducted on PubMed to December 2014. Priority was given to peer-reviewed papers published in scientific journals, although for many issues evidence includes conference abstracts listed on the Embase database. In addition, for 'Identification of problematic recreational drug and alcohol use' section and 'Sexual problems and dysfunctions in MSM' section, searches included PsycINFO. Methods Article titles and abstracts were reviewed and if relevant the full text article was obtained. Priority was given to randomised controlled trial and systematic review evidence, and recommendations made and graded on the basis of best available evidence. Piloting and feedback The first draft of the guideline was circulated to the writing group and to a small group of relevant experts, third sector partners and patient representatives who were invited to comment on the whole document and specifically on particular sections. The revised draft was reviewed by the CEG and then reviewed by the BASHH patient/public panel and posted on the BASHH website for public consultation. The final draft was piloted before publication. Guideline update The guidelines will be reviewed and revised in five years' time, 2022.
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Affiliation(s)
| | - David Asboe
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - Tristan Barber
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | | | - Nigel Field
- 4 Public Health England, London, UK
- 5 University College London, London, UK
| | | | | | - Rachael Jones
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | | | - Achyuta V Nori
- 8 8945 Guy's and St Thomas' NHS Foundation Trust , London, UK
| | - Michael Rayment
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - Ann Sullivan
- 9 BASHH CEG, BASHH 2017 Registered Office, Macclesfield, UK
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Herpes Simplex Proctitis Mimicking Inflammatory Bowel Disease in a Teenaged Male. Case Rep Pediatr 2017; 2017:3547230. [PMID: 28473937 PMCID: PMC5394410 DOI: 10.1155/2017/3547230] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 03/28/2017] [Indexed: 01/02/2023] Open
Abstract
We report the case of a 17-year-old male who was initially assessed for pain with defecation, bloody rectal discharge, and diarrhea, consistent with proctitis. Though proctitis is most commonly due to inflammatory bowel disease (IBD), infectious etiologies must also be considered, including sexually transmitted causes of infectious proctitis. In discussion of his sexual history, he identified as homosexual and acknowledged engaging in receptive anal intercourse. Rectal biopsies obtained via colonoscopy were culture-positive for herpes simplex virus (HSV), leading to a diagnosis of HSV proctitis and treatment with an appropriate antiviral medication. HSV proctitis is more common in individuals with high-risk sexual practices, including men who have sex with men. While this may be an uncommon diagnosis for pediatricians to make in practice, a high clinical index of suspicion for sexually transmitted infectious proctitis in those with risk factors must be maintained in order to facilitate appropriate testing, treatment, and counseling of affected individuals.
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What is causing this man's rectal pain and urinary retention? JAAPA 2016; 29:60-2. [DOI: 10.1097/01.jaa.0000496967.42862.a8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cox C, Watt AP, McKenna JP, Coyle PV. Gardnerella vaginalis and Mollicute detection in rectal swabs from men who have sex with men. Int J STD AIDS 2016; 28:708-714. [PMID: 27542698 DOI: 10.1177/0956462416665060] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The numbers of rectal sexually transmitted infections are on the rise especially among men who have sex with men. Males from men who have sex with men population are encouraged to send a rectal swab to the laboratory for sexually transmitted infection screening at their visit to the Genitourinary Medicine Clinic. In healthy asymptomatic males, the range of pathogens tested is limited therefore other pathogens may be left untreated allowing infections to persist among sexual partners. Molecular techniques have revolutionarised sexually transmitted infection testing enabling the detection of previously difficult-to-culture pathogens in extra-genital sites and have increased the evidence base for their clinical significance. The present study tests 107 rectal swabs from men who have sex with men negative for Chlamydia trachomatis and Neisseria gonorrhoeae against quantitative polymerase chain reaction (qPCR) assays targeting five common sexually transmitted bacteria which include Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum, Ureaplasma parvum and Gardnerella vaginalis. The pathogenic role of these five bacteria in men who have sex with men is currently unknown. Amongst the 107 patients, a positive qPCR was obtained respectively for G. vaginalis 89 (83.2%); U. urealyticum 26 (24.3%); M. hominis 26 (24.3%); M. genitalium 10 (9.3%) and U. parvum 5 (4.7%). Bacterial loads in single and co-infections were compared for each organism. G. vaginalis and M. hominis loads were significantly ( p = 0.007 and p = 0.005, respectively) higher when co-infecting with at least one other organism. Amongst co-infections, the loads of each organism were assessed to determine possible synergies. G. vaginalis and M. hominis displayed a synergistic pattern ( r = 0.51; p = 0.02) which is in keeping with a similar synergy detected previously in the vagina of women with bacterial vaginosis. This study outlines that potential significant infections are being missed in men who have sex with men population; however, further research is warranted to confirm a pathogenesis in the rectal mucosa before routine screening can be introduced to clinical settings.
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Affiliation(s)
- Ciara Cox
- Regional Virus Laboratory, Belfast Health and Social Care Trust, Northern Ireland and Centre for Infection and Immunity, Queens University Belfast, Belfast, Northern Ireland
| | - Alison P Watt
- Regional Virus Laboratory, Belfast Health and Social Care Trust, Northern Ireland and Centre for Infection and Immunity, Queens University Belfast, Belfast, Northern Ireland
| | - James P McKenna
- Regional Virus Laboratory, Belfast Health and Social Care Trust, Northern Ireland and Centre for Infection and Immunity, Queens University Belfast, Belfast, Northern Ireland
| | - Peter V Coyle
- Regional Virus Laboratory, Belfast Health and Social Care Trust, Northern Ireland and Centre for Infection and Immunity, Queens University Belfast, Belfast, Northern Ireland
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Zeidman JA, Shellito PC, Davis BT, Zukerberg LR. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 25-2016. A 33-Year-Old Man with Rectal Pain and Bleeding. N Engl J Med 2016; 375:676-82. [PMID: 27532834 DOI: 10.1056/nejmcpc1602815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jessica A Zeidman
- From the Departments of Medicine (J.A.Z., B.T.D.), Surgery (P.C.S.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Medicine (J.A.Z., B.T.D.), Surgery (P.C.S.), and Pathology (L.R.Z.), Harvard Medical School - both in Boston
| | - Paul C Shellito
- From the Departments of Medicine (J.A.Z., B.T.D.), Surgery (P.C.S.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Medicine (J.A.Z., B.T.D.), Surgery (P.C.S.), and Pathology (L.R.Z.), Harvard Medical School - both in Boston
| | - Benjamin T Davis
- From the Departments of Medicine (J.A.Z., B.T.D.), Surgery (P.C.S.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Medicine (J.A.Z., B.T.D.), Surgery (P.C.S.), and Pathology (L.R.Z.), Harvard Medical School - both in Boston
| | - Lawrence R Zukerberg
- From the Departments of Medicine (J.A.Z., B.T.D.), Surgery (P.C.S.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Medicine (J.A.Z., B.T.D.), Surgery (P.C.S.), and Pathology (L.R.Z.), Harvard Medical School - both in Boston
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Abstract
Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and management of common anorectal emergencies such as acutely thrombosed external hemorrhoid, thrombosed or strangulated internal hemorrhoid, bleeding hemorrhoid, bleeding anorectal varices, anal fissure, irreducible or strangulated rectal prolapse, anorectal abscess, perineal necrotizing fasciitis (Fournier gangrene), retained anorectal foreign bodies and obstructing rectal cancer. Sexually transmitted diseases as anorectal non-surgical emergencies and some anorectal emergencies in neonates are also discussed. The last part of this review dedicates to the management of early complications following common anorectal procedures that may present as an emergency including acute urinary retention, bleeding, fecal impaction and anorectal sepsis. Although many of anorectal disorders presenting in an emergency setting are not life-threatening and may be successfully treated in an outpatient clinic, an accurate diagnosis and proper management remains a challenging problem for clinicians. A detailed history taking and a careful physical examination, including digital rectal examination and anoscopy, is essential for correct diagnosis and plan of treatment. In some cases, some imaging examinations, such as endoanal ultrasonography and computerized tomography scan of whole abdomen, are required. If in doubt, the attending physicians should not hesitate to consult an expert e.g., colorectal surgeon about the diagnosis, proper management and appropriate follow-up.
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Abstract
Sexually transmitted infections (STIs) remain a significant burden on public health in the United States. Primary prevention counseling with early diagnosis and treatment remain the best methods to decrease the incidence of STIs. Through significant public heath interventions, the incidence of gonorrhea, Chlamydia, and trichomoniasis is decreasing; however, the incidence of primary and secondary syphilis is increasing. Human papilloma virus remains the most common STI, but new vaccinations have the possibility of having a significant impact on this virus's disease potential. This review discusses the most common STIs in the United States, focusing on clinical presentation, diagnosis, and treatment.
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Affiliation(s)
- Lindsay Smith
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, 645 North Michigan Avenue, Suite 900, Chicago, IL 60611, USA
| | - Michael P Angarone
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, 645 North Michigan Avenue, Suite 900, Chicago, IL 60611, USA.
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Patel R, Green J, Clarke E, Seneviratne K, Abbt N, Evans C, Bickford J, Nicholson M, O'Farrell N, Barton S, FitzGerald M, Foley E. 2014 UK national guideline for the management of anogenital herpes. Int J STD AIDS 2015; 26:763-76. [PMID: 25861804 DOI: 10.1177/0956462415580512] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 03/13/2015] [Indexed: 11/16/2022]
Abstract
These guidelines concern the management of anogenital herpes simplex virus infections in adults and give advice on diagnosis, management, and counselling of patients. This guideline replaces the 2007 BASHH herpes guidelines and includes new sections on herpes proctitis, key points to cover with patients regarding transmission and removal of advice on the management of HSV in pregnancy which now has a separate joint BASHH/RCOG guideline.
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Affiliation(s)
- Raj Patel
- Royal South Hants Hospital, Southampton, UK
| | | | | | | | - Naomi Abbt
- Buckinghamshire Healthcare NHS Trust, UK
| | - Ceri Evans
- Chelsea and Westminster Hospital, London, UK
| | | | | | | | | | - Mark FitzGerald
- British Association for Sexual Health and HIV Clinical Effectiveness Group, London, UK
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Ali MA, Arnold CA, Singhi AD, Voltaggio L. Clues to uncommon and easily overlooked infectious diagnoses affecting the GI tract and distinction from their clinicopathologic mimics. Gastrointest Endosc 2014; 80:689-706. [PMID: 25070906 DOI: 10.1016/j.gie.2014.04.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 04/29/2014] [Indexed: 02/07/2023]
Affiliation(s)
- M Aamir Ali
- Department of Gastroenterology, George Washington University Hospital, Washington, District of Columbia, USA
| | | | - Aatur D Singhi
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lysandra Voltaggio
- Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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The etiology of infectious proctitis in men who have sex with men differs according to HIV status. Sex Transm Dis 2014; 40:768-70. [PMID: 24275725 DOI: 10.1097/olq.0000000000000022] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We compared the spectrum of pathogens responsible for infectious proctitis between HIV-positive and HIV-negative men who have sex with men. Only 32% of men with herpes simplex virus (HSV)-associated proctitis had visible external anal ulceration.The etiology of infectious proctitis among HIV-positive and HIV-negative men is as follows: chlamydia (23.4% vs. 21.7%, P = 0.7), gonorrhea (13.4% vs. 10.8%, P = 0.5), HSV-1 (14.2% vs. 6.5%, P = 0.04), HSV-2 (22% vs. 12.3%, P = 0.03), lymphogranuloma venereum (7.8% vs. 0.7%, P = 0.004), and multiple infections (17.7% vs. 8.6%, P = 0.017). Thirty-two percent with HSV proctitis had external anal ulceration.
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40
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Zhao L, Hart J. Histologic mimics of inflammatory bowel disease. Semin Diagn Pathol 2014; 31:137-51. [PMID: 24815939 DOI: 10.1053/j.semdp.2014.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This review summarizes a variety of clinical and histologic mimics of idiopathic inflammatory bowel disease. All the entities that are included demonstrate one or more histologic features typical of idiopathic inflammatory bowel disease that may lead to potential diagnostic confusion and misinterpretation by the pathologist. The elements of the clinical history, laboratory test results, and endoscopic findings that are helpful to the surgical pathologist in considering a diagnosis other than idiopathic inflammatory bowel disease are emphasized. On occasion, a poor response to standard treatment for idiopathic inflammatory bowel disease is the clue that prompts reconsideration of the initial diagnosis. Subtle histologic features, special stains, or other diagnostic methodologies that can aid in proper diagnosis are also discussed.
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Affiliation(s)
- Lei Zhao
- Department of Pathology, University of Chicago Medical Center, 5840 S. Maryland Ave., MC6101 Chicago, Illinois 60637
| | - John Hart
- Department of Pathology, University of Chicago Medical Center, 5840 S. Maryland Ave., MC6101 Chicago, Illinois 60637.
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Markowicz M, Grilnberger E, Huber F, Leibl G, Abrahamian H, Gartner M, Huber M, Chott A, Reiter M, Stanek G. Case report: lymphogranuloma venereum proctitis—from rapid screening to molecular confirmation of a masked sexually transmitted disease. Diagn Microbiol Infect Dis 2013; 76:516-7. [DOI: 10.1016/j.diagmicrobio.2013.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 05/14/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
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Cytomegalovirus proctitis: a rare and disregarded sexually transmitted disease. Sex Transm Dis 2013; 38:876-8. [PMID: 21844745 DOI: 10.1097/olq.0b013e31821a5a90] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A review of published cases and a recently managed patient is presented, which describes the clinical features of cytomegalovirus proctitis. About half of the reports describe sexually transmitted cytomegalovirus proctitis following anal intercourse, which typically presents with rectal bleeding and a mononucleosis-like syndrome. This condition resolves spontaneously and may be associated with human immunodeficiency virus infection.
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Kobayashi KI, Yanagisawa N, Suganuma A, Imamura A, Ajisawa A. [Syphilis proctitis complicated with HIV infection: a case report]. ACTA ACUST UNITED AC 2012; 86:415-8. [PMID: 22991849 DOI: 10.11150/kansenshogakuzasshi.86.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We report on a 26-year-old Japanese man who was referred to our hospital because of anal pain and hematochezia. On admission, in addition to his gastrointestinal symptoms, a generalized maculopapular rash was observed, involving the palms of his hands and soles of his feet. His history and physical examination were compatible with syphilis, confirmed by a high syphilis titer on blood examination. Further tests revealed the presence of HIV infection, with a CD4 cell count of 227/microL. Colonoscopy demonstrated a deep ulcer in the lower rectum, although biopsy specimens did not reveal any syphilis spirochetes, or any other specific microorganisms. Intravenous penicillin G was initiated, resulting in a dramatic improvement of the ulcers along with the skin lesions confirming the diagnosis of syphilis proctitis. A rapid plasma reagin titer test performed 3 months after treatment demonstrated significant decrease, indicating successful treatment.
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Tigchelaar CK, Brosens LAA, Seldenrijk CA. An unusual rectal mass. Gastroenterology 2012; 143:e16-e17. [PMID: 22841728 DOI: 10.1053/j.gastro.2012.02.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 02/20/2012] [Accepted: 02/29/2012] [Indexed: 12/02/2022]
Affiliation(s)
- Claudia K Tigchelaar
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Lodewijk A A Brosens
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Pathology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - Cees A Seldenrijk
- Department of Pathology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
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45
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Hoentjen F, Rubin DT. Infectious proctitis: when to suspect it is not inflammatory bowel disease. Dig Dis Sci 2012; 57:269-73. [PMID: 21994137 DOI: 10.1007/s10620-011-1935-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 09/26/2011] [Indexed: 12/27/2022]
Abstract
BACKGROUND Proctitis is a common problem and is most frequently associated with inflammatory bowel diseases. However, the incidence of infectious proctitis appears to be rising, especially in men who have sex with men. This may be due to the rise of people participating in receptive anal sex as well as the increase in sexually transmitted infections. The most frequently reported pathogens include Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, and herpes simplex. DIAGNOSIS Symptoms of infectious proctitis can include rectal blood and mucous discharge, anorectal pain, ulcers, and occasionally lymphadenopathy and fever. History and physical examination are crucial in establishing a diagnosis, supported by endoscopy, histology, serology, culture and PCR. TREATMENT Treatment with antibiotics or antivirals is usually initiated, either empirically or after establishing a diagnosis. Co-infections, HIV testing, and treatment of sexual partners should always be considered.
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Affiliation(s)
- Frank Hoentjen
- Inflammatory Bowel Disease Center, University of Chicago Medical Center, 5841 S. Maryland Avenue, MC4076, Chicago, IL 60637, USA.
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46
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Chen MY, Read TRH, Leslie DE, Bissessor M. A couplet: a case of anal ulceration and another of inguinal swelling. Med J Aust 2011; 195:47-8. [PMID: 21728945 DOI: 10.5694/j.1326-5377.2011.tb03191.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 04/18/2011] [Indexed: 11/17/2022]
Affiliation(s)
- Marcus Y Chen
- Melbourne School of Population Health, University of Melbourne, Melbourne, VIC
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47
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48
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Ng BE, Rutherford GW, Broad AL, Moore DM. Antiviral therapy for genital herpes for prevention of HIV transmission. Hippokratia 2011. [DOI: 10.1002/14651858.cd006492.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Brian E Ng
- The University of British Columbia; School of Population and Public Health; Vancouver BC Canada
| | - George W Rutherford
- University of California, San Francisco; Global Health Sciences; 50 Beale Street Suite 1200 San Francisco California USA 94105
| | - Angela L Broad
- University of California, San Francisco; Global Health Sciences; 50 Beale Street Suite 1200 San Francisco California USA 94105
| | - David M Moore
- University of British Columbia; BC Centre for Excellence in HIV/AIDS; Vancouver British Columbia Canada
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Bhaijee F, Subramony C, Tang SJ, Pepper DJ. Human immunodeficiency virus-associated gastrointestinal disease: common endoscopic biopsy diagnoses. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:247923. [PMID: 21559197 PMCID: PMC3090068 DOI: 10.4061/2011/247923] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 02/07/2011] [Indexed: 12/25/2022]
Abstract
THE GASTROINTESTINAL (GI) TRACT IS A MAJOR SITE OF DISEASE IN HIV INFECTION: almost half of HIV-infected patients present with GI symptoms, and almost all patients develop GI complications. GI symptoms such as anorexia, weight loss, dysphagia, odynophagia, abdominal pain, and diarrhea are frequent and usually nonspecific among these patients. Endoscopy is the diagnostic test of choice for most HIV-associated GI diseases, as endoscopic and histopathologic evaluation can render diagnoses in patients with non-specific symptoms. In the past three decades, studies have elucidated a variety of HIV-associated inflammatory, infectious, and neoplastic GI diseases, often with specific predilection for various sites. HIV-associated esophageal disease, for example, commonly includes candidiasis, cytomegalovirus (CMV) and herpes simplex virus (HSV) infection, Kaposi's sarcoma (KS), and idiopathic ulceration. Gastric disease, though less common than esophageal disease, frequently involves CMV, Mycobacterium avium-intracellulare (MAI), and neoplasia (KS, lymphoma). Small bowel biopsies and intestinal aspirates from HIV-infected patients often show HIV enteropathy, MAI, protozoa (Giardia, Isospora, Cryptosporidia, amebae, Microsporidia), and helminths (Strongyloides stercoralis). Colorectal biopsies demonstrate viral (CMV, HSV), bacterial (Clostridia, Salmonella, Shigella, Campylobacter), fungal (cryptococcosis, histoplasmosis), and neoplastic (KS, lymphoma) processes. Herein, we review HIV-associated GI pathology, with emphasis on common endoscopic biopsy diagnoses.
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Affiliation(s)
- Feriyl Bhaijee
- Department of Pathology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA
| | - Charu Subramony
- Department of Pathology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA
| | - Shou-Jiang Tang
- Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA
| | - Dominique J. Pepper
- Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA
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50
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Acute Cytomegalovirus Proctitis in an Immunocompetent Man After Receptive Anal Intercourse. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2011. [DOI: 10.1097/ipc.0b013e3181eaf9e0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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