Proctitis in gay and bisexual men. Are microscopy and proctoscopy worthwhile?

Area of Science:

• Sexual health
• Infectious diseases
• Gastroenterology

Background:

• Rectal infections are common among gay and bisexual men (GBM).
• Accurate diagnosis of rectal sexually transmitted infections (STIs) is crucial for effective management.
• Nucleic acid amplification testing (NAAT) is a sensitive method for detecting rectal STIs.

Purpose of the Study:

• To investigate the association between nucleic acid amplification testing (NAAT) and rectal microscopy/proctoscopy findings.
• To identify correlates of rectal STIs among gay and bisexual men (GBM) diagnosed with proctitis.

Main Methods:

• Analysis of case files from 150 GBM diagnosed with proctitis.
• Examination of risk behaviors, microscopy, proctoscopy, and NAAT results for various rectal STIs.
• Statistical assessment using chi-squared tests and linear regression.

Main Results:

• Rectal discharge on proctoscopy, HIV positivity, and time since last receptive anal intercourse were associated with NAAT-positive rectal STIs.
• Microscopy findings showed no significant association with NAAT results or the number of rectal STIs.
• A quarter of GBM had negative proctoscopy findings, highlighting potential diagnostic challenges.

Conclusions:

• Rectal microscopy is not a reliable tool for guiding proctitis management in GBM.
• Rectal discharge identified during proctoscopy is a potential indicator for rectal STIs in this population.
• Consideration should be given to performing NAAT and proctoscopy for diagnosing rectal STIs in GBM.