Clinical diagnostic and therapeutic aspects of 221 consecutive anorectal Chlamydia trachomatis and Neisseria gonorrhoeae sexually transmitted infections among men who have sex with men.

OBJECTIVES: Proctitis caused by Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are known as sexually transmitted infections (STI). This study describes their clinical, diagnostic and therapeutic aspects. METHODS: Between 01/2013-03/2015, all MSM consulting for proctitis at proctology Institute-Saint-Joseph's Hospital, Paris, were included. Demographic, past-medical history, STI status and medical treatment were collected. Detection of CT/NG was performed by Transcription-Mediated Amplification (TMA) and antimicrobial susceptibilities for Ng by agar diffusion method. RESULTS: On 441 rectal samples collected, 221 (50.1%) were positive: 109 Ct (49.3%), 70 Ng (31.7%), 42 positive for both etiologies (19%). Among Ng infections, no resistance was detected to azithromycin and ceftriaxone. However, 84 strains (43.2%) were resistant to fluoroquinolones. More than one episode was diagnosed for 10 (5.1%) and 12 (6.2%) patients with CT and NG infections respectively. Anal abscesses were found for 27 (13.9%) patients, and 14 (7.2%) of them underwent surgery for anal fistula. CONCLUSIONS: The prevalence of CT/NG anorectal infections described is high on symptomatic patients, and a significant level of abscess was reported. These results confirm the interest of the association of recommended antibiotics excluding quinolones. Prospective studies would be relevant on complicated forms of anorectal infections.

Clinical Characteristics of Anorectal Mycoplasma genitalium Infection and Microbial Cure in Men Who Have Sex With Men.

BACKGROUND: We report clinical characteristics of proctitis caused solely by Mycoplasma genitalium (MG) compared with chlamydia and gonococcus. We determined the proportions cured with first-line (azithromycin) and second-line antimicrobials (moxifloxacin, pristinamycin). METHODS: A total of 166 patients attending Melbourne Sexual Health Centre from 2012 to 2016 with symptoms of proctitis were tested for MG, Chlamydia trachomatis, and Neisseria gonorrhoeae. Demographic characteristics, sexual behaviors, clinical symptoms, and signs were recorded. Multinomial multivariable logistic regression was used to test for significant differences in symptoms and signs for the pathogens detected. RESULTS: Seventeen percent of men had MG (95% confidence interval, 12-24), 21% had chlamydia (15-27), and 40% had gonococcal monoinfection (32-48), whereas 22% had MG coinfection (16-29). Relative to men with MG monoinfection, those with chlamydial monoinfection reported more anal pain (adjusted prevalence odds ratio (aPOR), 4.68 [1.41-14.19]), whereas men with gonococcal monoinfection reported more anal pain (aPOR, 6.75 [2.21-20.55]) and tenesmus (aPOR, 15.44 [1.62-146.90]), but less anal itch (aPOR, 0.32 [0.11-0.93]). The microbiological cure for MG using azithromycin was low at 35% (22-50), whereas moxifloxacin subsequently cured 92% (64-100) and pristinamycin cured 79% (54-94) of infections. CONCLUSIONS: M. genitalium was almost as common as chlamydia in men presenting to a sexual health center with symptoms of proctitis. Men with anorectal MG monoinfection were less likely to have symptoms and signs compared with those with chlamydia or gonococcus monoinfection. Cure for men with symptomatic anorectal MG by azithromycin was low. We suggest routine testing for MG in cases of proctitis, with test of cure after treatment being essential.

Bubonic lymphogranuloma venereum with multidrug treatment failure.

A patient with proctitis and inguinal buboes diagnosed with lymphogranuloma venereum (LGV) was treated with doxycycline 21 days, azithromycin 20 days and moxifloxacin for a further 12 days because of progressive worsening of inguinal symptoms. Despite extensive antibiotic treatment, the inguinal LGV lesions persisted; however, the patient recovered spontaneously after three months.

Doxycycline failure in lymphogranuloma venereum.

Lymphogranuloma venereum (LGV) cases are currently re-emerging in the homosexual community, particularly in HIV-seropositive patients. The standard treatment for this infection, which is caused by Chlamydia trachomatis L1, L2 and L3 serotypes, is a 3-week doxycycline regimen. The case is reported of a male patient presenting with LGV, who was rapidly cured with moxifloxacin treatment after failure of extended treatment with cyclines. This fluoroquinolone is known to be highly active in vitro on the LGV pathogenic agent. Thus it may be a useful alternative when doxycycline treatment results in failure.

[Antibiotherapy applied to uncomplicated urethritis and cervicitis. French Agency for Health Product Safety]. / Traitement antibiotique des urétrites et cervicites non compliquées. Agence française de sécurité sanitaire des produits de santé.

In sexually transmitted infections and more precisely in uncomplicated urethritis and cervicitis, the two infectious agents most commonly identified in France are Neisseria gonorrhoeae (gonococci) and Chlamydia trachomatis, alone or associated. The resistance of N. gonorrhoeae to ciprofloxacin has reached over 20 % in France. A new national strategy for the therapeutic management of probabilistic treatment applied to uncomplicated urethritis and cervicitis is required. Bacteriological sampling before treatment is mandatory. Anti-gonococcal probabilistic treatment is a monodose using one of the following molecules: third generation cephalosporin: ceftriaxone (intra-muscular or intra-venous), cefixime (oral); aminoside: spectinomycin (intra- muscular); fluoroquinolone (bacteriologically controlled): ciprofloxacin (oral); An oral anti-Chlamydia treatment must be associated: azithromycin (monodose); or doxycycline (standard treatment). Blood tests (screening for syphilis, HIV infection, hepatitis B, hepatitis C) must be performed taking into account the delay for sero-conversion. Hepatitis B vaccination must be offered to any non-immunized patient. Protected intercourse (using condoms) must be recommended.

[Anaerobic paraproctitis]. / Anaérobnyi paraproktit.

The authors had 80 patients, most of them (90%) of an old age, with anaerobic paraproctitis. Delayed hospitalization was encountered in 62 cases, in 16 of these cases an erroneous diagnosis had been established. Severe concomitant diseases complicated the course of anaerobic paraproctitis in 80% of cases (in each group of three patients one had diabetes mellitus). The authors describe characteristic clinical manifestations and the course of various forms of anaerobic paraproctitis, the results of bacteriological examination, and the order in which the surgical treatment is applied. They suggest a scheme of drug therapy which is maximally approximated to cleansing of a microbial cenosis, including ultraviolet irradiation of the blood. All these measures allowed the mortality rate to be decreased from 33.3% to 17.7%.