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Annals of Internal Medicine Mar 1977Anorectal gonococcal infection is common in women and homosexual men. In women with uncomplicated gonorrhea, the mean prevalence rate of anorectal involvement is 44%,... (Review)
Review
Anorectal gonococcal infection is common in women and homosexual men. In women with uncomplicated gonorrhea, the mean prevalence rate of anorectal involvement is 44%, with lone involvement of the anorectum in 4%. Among homosexual men with gonorrhea, anorectal infection occurs in 45%, although more than 90% of all male patients with anorectal gonorrhea admit to homosexual rectal intercourse. This infection is usually asymptomatic but occasionally presents with acute or chronic symptoms that mimic other causes of proctitis. Whereas currently recommended regimens for uncomplicated gonorrhea appear effective for anorectal gonorrhea in women, results in men have not been adequately evaluated. Available data showed failure rates from 7% to 35%; however, only one study used a currently accepted regimen. Further controlled studies in male patients with anorectal gonorrhea are clearly needed to establish optimal therapeutic regimens. Diligent contact tracing of all male homose.xual cases appears to be the only effective means of control at present.
Topics: Anti-Bacterial Agents; Anus Diseases; Biopsy; California; Female; Gonorrhea; Homosexuality; Humans; Male; Neisseria gonorrhoeae; Proctoscopy; Rectal Diseases
PubMed: 402879
DOI: 10.7326/0003-4819-86-3-340 -
American Journal of Clinical Pathology Nov 2022Neisseria gonorrhoeae infection of the anorectal tract is often asymptomatic and infrequently biopsied, but pathologists can be tasked with identifying the histologic...
OBJECTIVES
Neisseria gonorrhoeae infection of the anorectal tract is often asymptomatic and infrequently biopsied, but pathologists can be tasked with identifying the histologic features of possible infection. The study was undertaken to better characterize clinical and morphologic features of confirmed anorectal gonococcal infection.
METHODS
From 2011 to 2020, 201 positive gonococcal nucleic acid amplification testing samples from 174 patients collected from the distal colorectum and/or anus were matched to eight patients with concurrent biopsy specimens of the distal anorectum. Complete demographic, clinical, and infectious information was collected for each biopsied patient. The histomorphologic features of each biopsy were systematically tabulated.
RESULTS
All eight gonococcal cases were obtained from men who have sex with men. Each case showed at least mild acute inflammation with moderate activity identified in one case with concurrent cytomegalovirus infection. Intense lymphoplasmacytic infiltration was not commonly seen (two of eight). Half of the cases showed mucosal ulceration, and seven of eight cases demonstrated lymphoid aggregates.
CONCLUSIONS
The microscopic features are mild compared with other well-described types of infectious proctitis, with most cases displaying mild acute inflammation and scattered lymphoid aggregates. These findings highlight the importance of obtaining a complete patient history and recommending additional infectious workup even when only subtle changes are present.
Topics: Male; Humans; Gonorrhea; Neisseria gonorrhoeae; Homosexuality, Male; Sexual and Gender Minorities; Inflammation; Chlamydia trachomatis
PubMed: 35938627
DOI: 10.1093/ajcp/aqac089 -
The Surgical Clinics of North America Dec 2023Anorectal emergencies are rare presentations of common anorectal disorders, and surgeons are often called on to assist in their diagnosis and management. Although most... (Review)
Review
Anorectal emergencies are rare presentations of common anorectal disorders, and surgeons are often called on to assist in their diagnosis and management. Although most patients presenting with anorectal emergencies can be managed nonoperatively or with a bedside procedure, surgeons must also be able to identify surgical anorectal emergencies, such as gangrenous rectal prolapse. This article provides a review of pertinent anatomy; examination techniques; and workup, diagnosis, and management of common anorectal emergencies including thrombosed hemorrhoids, incarcerated hemorrhoids, anal fissure, anorectal abscess, rectal prolapse, and pilonidal abscess and unique situations including rectal foreign body and anorectal sexually transmitted infections.
Topics: Humans; Hemorrhoids; Rectal Prolapse; Abscess; Emergencies; Rectal Diseases; Anus Diseases; Fissure in Ano
PubMed: 37838461
DOI: 10.1016/j.suc.2023.05.014 -
Diseases of the Colon and Rectum Mar 2021
Topics: Abscess; Anal Canal; Bacterial Infections; Humans; Intestinal Fistula; Rectal Diseases
PubMed: 33399409
DOI: 10.1097/DCR.0000000000001911 -
MMWR. Morbidity and Mortality Weekly... Dec 2020Sexually transmitted infections (STIs) caused by the bacteria Neisseria gonorrhoeae (gonococcal infections) have increased 63% since 2014 and are a cause of sequelae...
Sexually transmitted infections (STIs) caused by the bacteria Neisseria gonorrhoeae (gonococcal infections) have increased 63% since 2014 and are a cause of sequelae including pelvic inflammatory disease, ectopic pregnancy, and infertility and can facilitate transmission of human immunodeficiency virus (HIV) (1,2). Effective treatment can prevent complications and transmission, but N. gonorrhoeae's ability to acquire antimicrobial resistance influences treatment recommendations and complicates control (3). In 2010, CDC recommended a single 250 mg intramuscular (IM) dose of ceftriaxone and a single 1 g oral dose of azithromycin for treatment of uncomplicated gonococcal infections of the cervix, urethra, and rectum as a strategy for preventing ceftriaxone resistance and treating possible coinfection with Chlamydia trachomatis (4). Increasing concern for antimicrobial stewardship and the potential impact of dual therapy on commensal organisms and concurrent pathogens (3), in conjunction with the continued low incidence of ceftriaxone resistance and the increased incidence of azithromycin resistance, has led to reevaluation of this recommendation. This report, which updates previous guidelines (5), recommends a single 500 mg IM dose of ceftriaxone for treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea. If chlamydial infection has not been excluded, concurrent treatment with doxycycline (100 mg orally twice a day for 7 days) is recommended. Continuing to monitor for emergence of ceftriaxone resistance through surveillance and health care providers' reporting of treatment failures is essential to ensuring continued efficacy of recommended regimens.
Topics: Administration, Oral; Ceftriaxone; Centers for Disease Control and Prevention, U.S.; Chlamydia Infections; Chlamydia trachomatis; Coinfection; Doxycycline; Evidence-Based Medicine; Gonorrhea; Humans; Injections, Intramuscular; Practice Guidelines as Topic; United States
PubMed: 33332296
DOI: 10.15585/mmwr.mm6950a6 -
Clinical Infectious Diseases : An... Mar 2023We performed anorectal testing in 18 cis-gender men who have sex with men with symptoms consistent with mpox virus (MPXV) infection. We found rectal MPXV DNA in 9/9 with...
We performed anorectal testing in 18 cis-gender men who have sex with men with symptoms consistent with mpox virus (MPXV) infection. We found rectal MPXV DNA in 9/9 with and 7/9 without proctitis. Future study of anorectal testing is needed and may inform the diagnosis and pathogenesis of MPXV disease.
Topics: Male; Humans; Mpox (monkeypox); Monkeypox virus; Homosexuality, Male; Sexual and Gender Minorities; Proctitis
PubMed: 36227656
DOI: 10.1093/cid/ciac825 -
Gastroenterology Clinics of North... Jun 2021Intra-abdominal and anorectal abscesses are common pathologies seen in both inpatient and outpatient settings. To decrease morbidity and mortality, early diagnosis and... (Review)
Review
Intra-abdominal and anorectal abscesses are common pathologies seen in both inpatient and outpatient settings. To decrease morbidity and mortality, early diagnosis and treatment are essential. After adequate drainage via a percutaneous or incisional approach, patients need to be monitored for worsening symptoms or recurrence and evaluated for the underlying condition that may have contributed to abscess formation.
Topics: Abdominal Abscess; Abscess; Crohn Disease; Drainage; Humans; Recurrence; Retrospective Studies
PubMed: 34024453
DOI: 10.1016/j.gtc.2021.02.014 -
Sexually Transmitted Infections Aug 2022Universal anorectal testing for (chlamydia) among women is not recommended in many countries, while anorectal chlamydia infections are common. Missed anorectal...
BACKGROUND
Universal anorectal testing for (chlamydia) among women is not recommended in many countries, while anorectal chlamydia infections are common. Missed anorectal infections might cause sequelae at the genital site if autoinoculation from the anorectum is possible, but evidence is limited. This study investigates the association between potentially missed anorectal infections and subsequent genital chlamydia infections in women, using not being tested at the anorectal site as a proxy for having a potentially missed anorectal infection.
METHODS
We included all women with a repeat chlamydia test within 1 year (with at least a genital test) from the Dutch sexual health centre surveillance between 2014 and 2019. Multilevel logistic regression analyses were used to identify determinants of genital chlamydia infection at the repeat test, with anorectal testing at the previous chlamydia test as the main determinant.
RESULTS
A total of 40 217 women were included in the analyses, of whom 15.4% tested chlamydia-positive genitally at their second test. Not being tested anorectally at the first test was an independent risk factor for genital chlamydia infection at the repeat test (adjusted OR 1.24, 95% CI 1.15 to 1.33). This association was in the same range as most other significant risk factors in the model: low education level, no condom use, STI symptoms and previous STI diagnosis. Young age (<20 years) (2.67, 2.39-2.98) and those who received partner notification (3.11, 2.91-3.31) showed stronger associations. The findings were robust; correcting for interactions and a sensitivity analysis stratifying by chlamydia infection at first visit did not show significant differences in the adjusted OR of not being tested anorectally at first test.
CONCLUSION
The results are suggestive of an autoinoculation process from the anorectal to the genital anatomical site in women. To enhance chlamydia control, future studies on the role of extragenital testing and autoinoculation in chlamydia transmission are needed.
Topics: Adult; Anal Canal; Chlamydia Infections; Chlamydia trachomatis; Female; Gonorrhea; Humans; Rectum; Sexual Behavior; Young Adult
PubMed: 34272331
DOI: 10.1136/sextrans-2021-054991 -
Therapeutische Umschau. Revue... 2021Sexually transmitted anorectal infections In recent years, the incidence of sexually transmitted infections in Switzerland has increased significantly for various... (Review)
Review
Sexually transmitted anorectal infections In recent years, the incidence of sexually transmitted infections in Switzerland has increased significantly for various reasons. They often manifest with anorectal symptoms, and may present as localized lesions, proctitis, or enteritis. To avoid misdiagnosis and stop transmissions to their sexual partners, testing for sexually transmitted diseases is indicated in most individuals with anorectal symptoms. This article provides an overview of the diagnosis and treatment of sexually transmitted anorectal infections.
Topics: Enteritis; Gastrointestinal Diseases; Humans; Proctitis; Sexual Behavior; Sexually Transmitted Diseases
PubMed: 34704471
DOI: 10.1024/0040-5930/a001308 -
Annales de Dermatologie Et de... Nov 2016
Topics: Anti-Infective Agents; Anus Diseases; Chancre; Chlamydia Infections; Giardiasis; Gonorrhea; Granuloma Inguinale; Herpes Genitalis; Humans; Syphilis, Cutaneous
PubMed: 27773510
DOI: 10.1016/j.annder.2016.09.020