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Journal of the European Academy of... Jul 2021This guideline intents to offer guidance on the diagnosis and management of patients with gastrointestinal symptoms and a suspected sexually transmitted cause. Proctitis...
This guideline intents to offer guidance on the diagnosis and management of patients with gastrointestinal symptoms and a suspected sexually transmitted cause. Proctitis is defined as an inflammatory syndrome of the anal canal and/or the rectum. Infectious proctitis can be sexually transmitted via genital-anal mucosal contact, but some also via digital contact and toys. Neisseria gonorrhoeae, Chlamydia trachomatis (including lymphogranuloma venereum), Treponema pallidum and herpes simplex virus are the most common sexually transmitted anorectal pathogens. Shigellosis can be transferred via oral-anal contact and may lead to proctocolitis or enteritis. Although most studies on these infections have concentrated on men who have sex with men (MSM), women having anal intercourse may also be at risk. A presumptive clinical diagnosis of proctitis can be made when there are symptoms and signs, and a definitive diagnosis when the results of laboratory tests are available. The symptoms of proctitis include anorectal itching, pain, tenesmus, bleeding, constipation and discharge in and around the anal canal. The majority of rectal chlamydia and gonococcal infections are asymptomatic and can only be detected by laboratory tests. Therefore, especially when there is a history of receptive anal contact, exclusion of anorectal infections is generally indicated as part of standard screening for sexually transmitted infections (STIs). Condom use does not guarantee protection from STIs, which are often spread without penile penetration. New in this updated guideline is: (i) lymphogranuloma venereum proctitis is increasingly found in HIV-negative MSM, (ii) anorectal Mycoplasma genitalium infection should be considered in patients with symptomatic proctitis after exclusion of other common causations such N. gonorrhoeae, C. trachomatis, syphilis and herpes, (iii) intestinal spirochetosis incidentally found in colonic biopsies should not be confused with syphilis, and (iv) traumatic causes of proctitis should be considered in sexually active patients.
Topics: Chlamydia trachomatis; Enteritis; Female; Homosexuality, Male; Humans; Male; Mycoplasma Infections; Mycoplasma genitalium; Proctitis; Proctocolitis; Sexual and Gender Minorities; Sexually Transmitted Diseases
PubMed: 34057249
DOI: 10.1111/jdv.17269 -
The New England Journal of Medicine Aug 2023
Topics: Humans; Proctitis; Syphilis
PubMed: 37522423
DOI: 10.1056/NEJMicm2301469 -
Lancet (London, England) Aug 2022In May, 2022, several European countries reported autochthonous cases of monkeypox, which rapidly spread globally. Early reports suggest atypical presentations. We aimed... (Observational Study)
Observational Study
BACKGROUND
In May, 2022, several European countries reported autochthonous cases of monkeypox, which rapidly spread globally. Early reports suggest atypical presentations. We aimed to investigate clinical and virological characteristics of cases of human monkeypox in Spain.
METHODS
This multicentre, prospective, observational cohort study was done in three sexual health clinics in Madrid and Barcelona, Spain. We enrolled all consecutive patients with laboratory-confirmed monkeypox from May 11 to June 29, 2022. Participants were offered lesion, anal, and oropharynx swabs for PCR testing. Participant data were collected by means of interviews conducted by dermatologists or specialists in sexually transmitted infections and were recorded using a standard case report form. Outcomes assessed in all participants with a confirmed diagnosis were demographics, smallpox vaccination, HIV status, exposure to someone with monkeypox, travel, mass gathering attendance, risk factors for sexually transmitted infections, sexual behaviour, signs and symptoms on first presentation, virological results at multiple body sites, co-infection with other sexually transmitted pathogens, and clinical outcomes 14 days after the initial presentation. Clinical outcomes were followed up until July 13, 2022.
FINDINGS
181 patients had a confirmed monkeypox diagnosis and were enrolled in the study. 166 (92%) identified as gay men, bisexual men, or other men who have sex with men (MSM) and 15 (8%) identified as heterosexual men or heterosexual women. Median age was 37·0 years (IQR 31·0-42·0). 32 (18%) patients reported previous smallpox vaccination, 72 (40%) were HIV-positive, eight (11%) had a CD4 cell count less than 500 cells per μL, and 31 (17%) were diagnosed with a concurrent sexually transmitted infection. Median incubation was 7·0 days (IQR 5·0-10·0). All participants presented with skin lesions; 141 (78%) participants had lesions in the anogenital region, and 78 (43%) in the oral and perioral region. 70 (39%) participants had complications requiring treatment: 45 (25%) had a proctitis, 19 (10%) had tonsillitis, 15 (8%) had penile oedema, six (3%) an abscess, and eight (4%) had an exanthem. Three (2%) patients required hospital admission. 178 (99%) of 180 swabs from skin lesions collected tested positive, as did 82 (70%) of 117 throat swabs. Viral load was higher in lesion swabs than in pharyngeal specimens (mean cycle threshold value 23 [SD 4] vs 32 [6], absolute difference 9 [95% CI 8-10]; p<0·0001). 108 (65%) of 166 MSM reported anal-receptive sex. MSM who engaged in anal-receptive sex presented with proctitis (41 [38%] of 108 vs four [7%] of 58, absolute difference 31% [95% CI 19-44]; p<0·0001) and systemic symptoms before the rash (67 [62%] vs 16 [28%], absolute difference 34% [28-62]; p<0·0001) more frequently than MSM who did not engage in anal-receptive sex. 18 (95%) of 19 participants with tonsillitis reported practising oral-receptive sex. The median time from onset of lesions to formation of a dry crust was 10 days (IQR 7-13).
INTERPRETATION
In our cohort, monkeypox caused genital, perianal, and oral lesions and complications including proctitis and tonsillitis. Because of the variability of presentations, clinicians should have a low threshold for suspicion of monkeypox. Lesion swabs showed the highest viral loads, which, combined with the history of sexual exposure and the distribution of lesions, suggests close contact is probably the dominant transmission route in the current outbreak.
FUNDING
None.
Topics: Adult; Female; HIV Infections; Homosexuality, Male; Humans; Male; Mpox (monkeypox); Monkeypox virus; Proctitis; Prospective Studies; Sexual Behavior; Sexual and Gender Minorities; Sexually Transmitted Diseases; Smallpox; Spain; Tonsillitis
PubMed: 35952705
DOI: 10.1016/S0140-6736(22)01436-2 -
MMW Fortschritte Der Medizin Oct 2023
Topics: Humans; Colitis, Ulcerative; Proctitis
PubMed: 37857975
DOI: 10.1007/s15006-023-3084-8 -
Digestive Diseases and Sciences Sep 2018Radiation proctitis is radiation-induced rectal mucositis, occurring as a result of radiation therapy for various pelvic malignancies. The management of radiation... (Review)
Review
Radiation proctitis is radiation-induced rectal mucositis, occurring as a result of radiation therapy for various pelvic malignancies. The management of radiation proctitis is challenging as guidelines are not currently available, and studies of the various treatment modalities are limited. There are various medical, endoscopic, and surgical measures for treating chronic radiation proctitis. Medical options such as anti-inflammatory agents, antioxidants, formalin application, and hyperbaric oxygen may improve bleeding related to chronic radiation proctitis. Endoscopic measures such as argon plasma coagulation are effective and safe. Surgery is considered for refractory or severe cases. A review and discussion of the different treatment modalities is presented.
Topics: Ablation Techniques; Argon Plasma Coagulation; Digestive System Surgical Procedures; Endoscopy, Gastrointestinal; Gastrointestinal Agents; Humans; Proctitis; Radiation Injuries; Radiotherapy; Risk Factors; Severity of Illness Index; Treatment Outcome
PubMed: 29948565
DOI: 10.1007/s10620-018-5163-8 -
Internal Medicine (Tokyo, Japan) Apr 2024
Topics: Humans; Chlamydia Infections; Proctitis; Chlamydia
PubMed: 37558471
DOI: 10.2169/internalmedicine.2396-23 -
Journal of Crohn's & Colitis Jul 2017
Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents, Non-Steroidal; Biological Products; Colitis, Ulcerative; Colon, Descending; Colon, Sigmoid; Consensus; Drug Therapy, Combination; Evidence-Based Medicine; Gastrointestinal Agents; Humans; Immunosuppressive Agents; Maintenance Chemotherapy; Mesalamine; Proctitis; Remission Induction; Tumor Necrosis Factor-alpha
PubMed: 28513805
DOI: 10.1093/ecco-jcc/jjx009 -
Der Hautarzt; Zeitschrift Fur... Apr 2020Herpes simplex virus (HSV) type 1 and type 2 may infect the anal region and induce aphthous ulcers. HSV-induced proctitis may be severe with fever, anal pain, anal... (Review)
Review
BACKGROUND
Herpes simplex virus (HSV) type 1 and type 2 may infect the anal region and induce aphthous ulcers. HSV-induced proctitis may be severe with fever, anal pain, anal bleeding, and diarrhea.
OBJECTIVES
The pathogenic agents and treatment are reviewed.
MATERIALS AND METHODS
A review of the current literature was performed.
RESULTS
The shift to later primary infections with HSV1 and changes towards more frequent oro-genital and oro-anal sex has increased the incidence of HSV1-induced primary anal infections. Due to frequent recurrences, HSV2 remains the most common cause of anal HSV infection. Anal and genital HSV infections are a risk factor for subsequent HIV infection. In case of suspicion, pathogen detection by polymerase chain reaction (PCR) should be performed and other sexually transmitted diseases should be excluded. HSV proctitis may mimic inflammatory bowel disease. Treatment should include antiviral medication as in genital herpes simplex.
CONCLUSIONS
HSV may induce perianal infections, anal infections and HSV proctitis. Diagnosis of HSV1 and HSV2 using PCR is recommended. Anal and genital HSV infections are a risk factor for subsequent HIV infection. The risk is higher for HSV2 infection due to more frequent recurrences.
Topics: Anus Diseases; HIV Infections; Herpes Genitalis; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Polymerase Chain Reaction; Proctitis; Sexual Behavior; Sexually Transmitted Diseases
PubMed: 31965208
DOI: 10.1007/s00105-019-04539-5 -
The New England Journal of Medicine Apr 2020
Topics: Abdominal Pain; Adult; Chlamydia trachomatis; Fatigue; Humans; Lymphogranuloma Venereum; Male; Proctitis; Rectum; Syphilis; Treponema pallidum
PubMed: 32320571
DOI: 10.1056/NEJMicm1906077 -
Scandinavian Journal of Gastroenterology Dec 2022Ulcerative colitis (UC) is an inflammatory bowel disease of unknown etiology. It is characterized by a chronic course with periods of aggravations and remissions. Among... (Review)
Review
Ulcerative colitis (UC) is an inflammatory bowel disease of unknown etiology. It is characterized by a chronic course with periods of aggravations and remissions. Among patients, 25-55% present with ulcerative proctitis (UP) at the time of diagnosis. UP is well-treated disease associated with a good prognosis. UP is characterized by a less aggressive course than the left-sided form of UC and pancolitis, with a good response to topical treatment. Moreover, UP is associated with a lower risk of severe aggravations and systemic and local complications and lower need for colectomy, hospitalization and glucocorticosteroids and immunosuppressive drugs, in comparison with more extensive forms of the disease. Thus, the key issue is to prognose the natural course of the disease in order to identify high-risk patients and apply biological or immunosuppressive treatment early to prevent the development of complications. In this review, we summarize the current knowledge about the natural course of UP and discuss risks and protective factors related to disease progression and current treatment concepts.
Topics: Humans; Colitis, Ulcerative; Immunosuppressive Agents; Colectomy; Risk Factors; Proctitis; Disease Progression
PubMed: 35793351
DOI: 10.1080/00365521.2022.2094726