Aseptic meningitis from herpes simplex virus proctitis

Area of Science:

• Infectious Diseases
• Gastroenterology
• Neurology

Background:

• Sexually transmitted proctitis is common in men who have sex with men (MSM), often caused by herpes simplex virus (HSV), Neisseria gonorrhoeae, and Chlamydia trachomatis.
• Herpes simplex virus-associated proctitis typically presents with visible lesions, but asymptomatic or covert cases can evade initial detection.

Observation:

• A case is presented of an MSM in his early 30s with dyschezia and perineal discomfort after unprotected anoreceptive intercourse.
• Initial examination revealed no external lesions, but rectal swabs confirmed herpes simplex virus type 2 (HSV-2) infection.
• The patient later developed purulent discharge, imaging showed mucosal thickening consistent with proctitis, and subsequently, symptoms of aseptic meningitis with HSV-2 DNA in cerebrospinal fluid.

Findings:

• This case demonstrates an atypical progression of HSV-2 proctitis.
• The infection presented without initial visible lesions, highlighting the potential for covert disease.
• The proctitis evolved to include neurological complications, specifically aseptic meningitis.

Implications:

• Heightened vigilance and comprehensive testing for HSV-2 are imperative in MSM engaging in receptive anal intercourse.
• Early detection and intervention are critical to prevent severe sequelae, including neurological complications.
• This case underscores the importance of considering HSV-2 in the differential diagnosis of proctitis and associated neurological symptoms in at-risk populations.