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Anorectal and enteric infections in homosexual men
Abstract:
Homosexual men are at increased risk for traditional sexually transmitted anorectal infections (gonorrhea, syphilis, venereal warts, herpes and chlamydial infection) and enteric infections characterized by a low infecting inoculum (hepatitis A and B, amebiasis, giardiasis, shigellosis and campylobacteriosis). Infections account for most of the gastrointestinal symptoms in homosexual men seen at sexually transmitted disease clinics, but asymptomatic and polymicrobial infections are also common. Distinguishing three syndromes-proctitis, proctocolitis and enteritis-is clinically useful because these syndromes correlate with specific microorganisms and modes of transmission. A careful anoscopic examination, rectal Gram's stain, cultures for gonorrhea and chlamydia, VDRL and darkfield examination of suspicious lesions should be routinely done when sexually active homosexual men present with unexplained gastrointestinal symptoms. Based on the history, physical examination and initial laboratory studies, patients can usually be classified as having proctitis, proctocolitis or enteritis. This distinction facilitates selection of both confirmatory diagnostic tests and antimicrobial therapy. The effectiveness of empiric treatment regimens for asymptomatic sexual contacts or for symptomatic patients in whom microbiological tests are pending has not been studied.
Insights
Homosexual men face higher risks for various sexually transmitted and enteric infections. Early diagnosis and classification of gastrointestinal symptoms into proctitis, proctocolitis, or enteritis are crucial for effective treatment.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Sexual Health
Background:
- Homosexual men are disproportionately affected by anorectal and enteric infections.
- Gastrointestinal symptoms in this population are often infection-related, including asymptomatic and polymicrobial cases.
Purpose of the Study:
- To highlight the clinical utility of differentiating between proctitis, proctocolitis, and enteritis.
- To guide diagnostic and therapeutic strategies for gastrointestinal infections in homosexual men.
Main Methods:
- Clinical evaluation including anoscopic examination.
- Routine laboratory tests: rectal Gram's stain, cultures for gonorrhea and chlamydia, VDRL, and darkfield examination.
- Classification of symptoms into proctitis, proctocolitis, or enteritis based on clinical presentation and initial tests.
Main Results:
- Syndromic classification (proctitis, proctocolitis, enteritis) correlates with specific pathogens and transmission routes.
- Initial diagnostic and antimicrobial therapy selection is facilitated by this classification.
Conclusions:
- Distinguishing between proctitis, proctocolitis, and enteritis is clinically valuable for managing gastrointestinal symptoms in homosexual men.
- Further research is needed on the effectiveness of empiric treatment for asymptomatic contacts and patients awaiting test results.