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1.
Sex Transm Dis ; 49(12): 860-862, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-35969837

RESUMO

ABSTRACT: We analyzed microbiologic etiologies of proctitis among patients seen in an urban sexual health clinic during 2011 to 2021. Among 759 cases, 179 (24%) tested positive for Neisseria gonorrhoeae , 171 (23%) for Chlamydia trachomatis , 21 (3%) for herpes simplex virus, 30 (4%) for syphilis, and 73 (10%) for multiple pathogens; no pathogen was identified in 425 (56%).


Assuntos
Infecções por Chlamydia , Gonorreia , Proctite , Saúde Sexual , Humanos , Gonorreia/complicações , Gonorreia/epidemiologia , Infecções por Chlamydia/complicações , Infecções por Chlamydia/epidemiologia , Washington/epidemiologia , Chlamydia trachomatis , Proctite/etiologia , Proctite/microbiologia , Neisseria gonorrhoeae
3.
Sex Transm Infect ; 96(7): 475-477, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32001659

RESUMO

OBJECTIVES: We explored the association between nucleic acid amplification testing (NAAT) and rectal microscopy/proctoscopy findings and correlates of rectal STIs among 150 gay and bisexual men (GBM) diagnosed with proctitis at the Sydney Sexual Health Centre from March 2016 to October 2017. METHODS: From case files, we analysed risk behaviours, microscopy, proctoscopy and NAAT results for rectal STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, herpes simplex virus type 1/2, lymphogranuloma venereum and syphilis). χ2 test assessed the association between microscopy/proctoscopy findings and NAAT results. Linear regression assessed the association between NAAT positivity and correlates of rectal STIs. RESULTS: The mean age was 32.5 (9.8) years, 43% (65/150) were taking pre-exposure prophylaxis, 17% (26/150) were HIV positive and 24% (36/147) had multiple rectal STIs.Among GBM with documented proctoscopy findings (n=113), 58% (65/113) had discharge, 36% (41/113) had anorectal erythema and 25% (28/113) had bleeding. A quarter of GBM (28/113) had negative proctoscopy findings.Discharge found on proctoscopy (p=0.001), positive HIV status (p=0.030) and time since last receptive anal intercourse (p=0.028) were independently associated with NAAT positivity for any rectal STI. Discharge had a positive likelihood ratio of 1.6 (95% CI 1.0 to 2.4).Among those with documented microscopy findings (n=69), 59% (41/69) and 41% (28/69) were NAAT positive and negative, respectively. Among NAAT-positive GBM, 27 (66%) had polymorphonuclear cells (PMNs) (mean number of PMNs, 10 (SD 9) cells per oil immersion field), 1 (2%) had Gram-negative intracellular diplococci and 11 (27%) had negative findings. There was no significant association between microscopy findings and NAAT results (p=0.651) or the number of rectal STI (p=0.279). CONCLUSION: Microscopy does not reliably provide information necessary to tailor the management of GBM diagnosed with proctitis. Discharge found during proctoscopy may identify GBM with rectal STI. Services should consider recommendations to perform these investigations.


Assuntos
Proctite/diagnóstico por imagem , Proctoscopia , Minorias Sexuais e de Gênero , Infecções Sexualmente Transmissíveis/diagnóstico , Adulto , Austrália/epidemiologia , Comportamentos de Risco à Saúde , Humanos , Masculino , Microscopia , Técnicas de Amplificação de Ácido Nucleico , Proctite/epidemiologia , Proctite/microbiologia , Proctite/patologia , Reto/diagnóstico por imagem , Reto/microbiologia , Reto/patologia , Sexualidade , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/microbiologia , Infecções Sexualmente Transmissíveis/patologia , Adulto Jovem
4.
Gastroenterology ; 158(6): 1546-1547, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32017908

Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Coinfecção/diagnóstico , Granuloma/diagnóstico , Proctite/diagnóstico , Infecções Sexualmente Transmissíveis/diagnóstico , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/imunologia , Antibacterianos/administração & dosagem , Antivirais/administração & dosagem , Ceftriaxona/administração & dosagem , Chlamydia trachomatis/genética , Chlamydia trachomatis/isolamento & purificação , Coinfecção/tratamento farmacológico , Coinfecção/imunologia , Coinfecção/microbiologia , Colonoscopia , Citomegalovirus/isolamento & purificação , DNA Bacteriano/isolamento & purificação , Doxiciclina/administração & dosagem , Quimioterapia Combinada/métodos , Granuloma/tratamento farmacológico , Granuloma/imunologia , Granuloma/microbiologia , Humanos , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/microbiologia , Mucosa Intestinal/patologia , Masculino , Pessoa de Meia-Idade , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/isolamento & purificação , Proctite/tratamento farmacológico , Proctite/imunologia , Proctite/microbiologia , Reto/diagnóstico por imagem , Reto/microbiologia , Reto/patologia , Infecções Sexualmente Transmissíveis/tratamento farmacológico , Infecções Sexualmente Transmissíveis/imunologia , Infecções Sexualmente Transmissíveis/microbiologia , Resultado do Tratamento , Valganciclovir/administração & dosagem
5.
Sex Transm Infect ; 96(2): 137-142, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31235527

RESUMO

OBJECTIVES: Understanding the public health impact of lymphogranuloma venereum (LGV) in Europe is hampered by inadequate diagnostics and surveillance systems in many European countries. We developed and piloted LGV surveillance in three European countries without existing systems and performed a preliminary investigation of LGV epidemiology, where little evidence currently exists. METHODS: We recruited STI or dermatovenereology clinics and associated laboratories serving men who have sex with men (MSM) in Austria, Croatia and Slovenia, using the UK for comparison. We undertook centralised LGV testing of Chlamydia trachomatis (CT)-positive rectal swabs collected between October 2016 and May 2017 from MSM attending these clinics. Stored specimens from Austria (2015-2016) and Croatia (2014) were also tested. Clinical and sociodemographic data were collected using a standardised proforma. The ompA gene of LGV-positive specimens was sequenced. RESULTS: In total, 500 specimens from CT-positive MSM were tested, and LGV positivity was 25.6% (128/500; 95% CI 22.0% to 29.6%) overall, and 47.6% (79/166; 40.1% to 55.2%) in Austria, 20.0% (3/15; 7.1% to 45.2%) in Croatia, 16.7% (1/6; 3.0% to 56.4%) in Slovenia and 14.4% (45/313; 10.9% to 18.7 %) in the UK. Proformas were completed for cases in Croatia, Slovenia and in the UK; proformas could not be completed for Austrian cases, but limited data were available from line listings. Where recorded, 83.9% (78/93) of LGV-CT cases were HIV-positive compared with 65.4% (149/228) of non-LGV-CT cases; MSM with LGV-CT were more likely to have proctitis (Austria, 91.8% vs 40.5%, p<0.001; Croatia, 100% vs 25%, p=0.04; UK, 52.4% vs 11.7%, p<0.001) than those with non-LGV-CT. Six different ompA sequences were identified, including three new variants; the L2 ompA sequence predominated (58.6%, 51/87). CONCLUSIONS: LGV is substantially underdiagnosed in MSM across Europe. Unified efforts are needed to overcome barriers to testing, establish effective surveillance, and optimise diagnosis, treatment and prevention.


Assuntos
Linfogranuloma Venéreo/epidemiologia , Proctite/epidemiologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Adulto , Áustria/epidemiologia , Proteínas da Membrana Bacteriana Externa/genética , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/microbiologia , Chlamydia trachomatis/genética , Coinfecção/epidemiologia , Croácia/epidemiologia , Monitoramento Epidemiológico , Europa (Continente)/epidemiologia , Gonorreia/epidemiologia , Infecções por HIV/epidemiologia , Humanos , Linfogranuloma Venéreo/diagnóstico , Linfogranuloma Venéreo/microbiologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Proctite/microbiologia , Reação em Cadeia da Polimerase em Tempo Real , Reto/microbiologia , Eslovênia/epidemiologia , Reino Unido/epidemiologia
6.
Rev. argent. coloproctología ; 30(4): 80-87, dic. 2019. graf, tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-1096677

RESUMO

Introducción: Las infecciones transmisibles sexualmente (ITS) con afectación anorrectal constituyen un desafío pues las manifestaciones producidas por Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) y Treponema pallidum (TP) son similares. Objetivo: Evaluar si las manifestaciones anorrectales debidas a CT, NG y TP asociadas al examen proctológico permiten diagnóstico certero, sin estudios complementarios. Pacientes y método: Estudio retrospectivo. Revisión de registros de pacientes atendidos en consultorio coloproctológico. Periodo: 01/08/2015-01/07/2016. Se incluyeron pacientes con diagnóstico de ITS anorrectal, excepto aquellos con HPV únicamente. A todos se les pesquisaron ITS mediante hisopado anal para CT por inmunofluorescencia y para estudio directo y cultivo de NG, VDRL para TP y además HIV. Variables: sexo, edad, HIV, sexo anal, uso de preservativo, motivo de consulta y resultado de estudios efectuados. Resultados: Treinta y cuatro pacientes (32 hombres). Edad mediana 31,5 años (rango: 19-65). Veinticinco pacientes HIV + (73,5%). Veintinueve pacientes (28 hombres) mantenían sexo anal. 91% no usaba preservativo adecuadamente. 65% tuvo una única infección (ITS pura). Se diagnosticaron 14 sífilis (8 puras), 14 clamidiasis (7 puras) y 11 gonococcias (7 puras). Co-infección entre ellas: 9% y con HPV: 26%. La úlcera fue la manifestación en 7/8 casos de sífilis puras (todas dolorosas, excepto una). El resto presentó síntomas variados (condilomas virales atípicos, secreción purulenta y proctorragia). Más del 50% de las gonococias puras (4/7) se manifestó con úlcera, sin embargo, el dolor estuvo presente siempre (8/8) y en tres se asoció secreción purulenta. En cambio, la mitad de los pacientes con clamidiasis puras, se manifestó con proctorragia causada por un tumor rectal/sigmoideo inflamatorio, clínicamente indistinguible de neoplasia maligna. Todos las sífilis y gonococias tuvieron correlato con las pruebas diagnósticas, no así las clamidiasis cuyo diagnóstico no pudo confirmarse en tres casos (37,5%), que respondieron al tratamiento empírico. Conclusión: NG y TP anorrectal provocaron mayormente síntomas similares a los de etiología no venérea y se requirió del laboratorio para el diagnóstico etiológico. La presencia de tumor con biopsia negativa para neoplasia maligna en pacientes de riesgo para ITS obliga a descartar clamidiasis. (AU)


Introduction: Sexually transmitted infections (STIs) are a challenge in medical consultation. The clinical manifestations of infection by Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Treponema pallidum ( TP) share symptoms at anorectal level. This implies the need for a high index of suspicion for diagnosis, which is based on history, physical examination and laboratory tests that not always are accurate or available . Purpose: Assess whether clinical signs of anorectal infections by CT, NG and TP associated with proctologic exams, lead to an accurate etiologic diagnosis without the help of specific laboratory studies. Patients and methods: Observational, retrospective study, based on a review of records of patients treated at the outpatient clinic of the Hospital Fernandez (City of Buenos Aires) department of coloproctology, in the period between August 2015 and July 2016. Patients who underwent STI diagnosis were all considered, but to those whose only diagnosis was infection by human papilloma virus (HPV) were excluded from the analysis. All patients were tested after the three etiologies of STI (anal swab for CT study by immunofluorescence, swabbing for direct study, and cultivation of NG and TP VDRL) and HIV. Variables analyzed: sex, age, presence of HIV infection, practice of receptive anal sex, proper use of condoms, signs and symptoms that prompted the consultation, and results of diagnostic tests. Results: 34 patients (32 men) were included. Median age 31.5 years (range: 19-65, interquartile range: 26-37). Twenty-five patients (73.5%) were HIV+. Twenty-nine patients (28 men) remained receptive anal sex. 91% did not use condoms properly. 65% of infections were pure, without other STI asociada-. 14 cases of syphilis (8 pure), 14 Chlamydia (7 pure) and 11 gonococcias (7puras), including co-infection in 9% of cases, no evidence of a more frequent another co-infection diagnosed. Co-infection with HPV was detected in 9 (26%) cases. The ulcer was the sign in 7/8 cases of pure syphilis (all painful, except one). The rest is expressed by a variety of symptoms (atypical viral warts, purulent and bloody diarrhea). Similarly, just over 50% (4/7) of pure gonococcias demonstrated ulcer, but the pain was always present (8/8 of pure gonococcias) and three associated with purulent discharge. Instead of the ten patients with pure chlamydia, 50% manifested with bloody diarrhea caused by a rectal tumor / inflammatory sigmoid, clinically indistinguishable from malignancy. All cases of syphilis and gonococcal were correlated with diagnostic tests; not those whose diagnosis of chlamydial infection (confirmed in eight and was negative in three, 37.5%) who responded to empiric treatment indicated by the clinical suspicion. Conclusion: While this is a small series, it shows that the NG and TP in the anorectal location mostly caused symptoms similar to those of non-venereal ethology most of the times, and laboratory assistance for etiologic diagnosis was required. The presence of tumor with negative biopsy for malignancy in patients at risk for STIs, leads chlamydia to be ruled out. (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Proctite/etiologia , Proctite/microbiologia , Doenças Bacterianas Sexualmente Transmissíveis/complicações , Doenças Bacterianas Sexualmente Transmissíveis/diagnóstico , Infecções por Chlamydia/diagnóstico , Gonorreia/diagnóstico , Sífilis/diagnóstico , Dor , Proctite/epidemiologia , Reto/microbiologia , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologia , Comorbidade , Infecções por HIV , Estudos Retrospectivos , Distribuição por Sexo , Técnicas de Laboratório Clínico
8.
Epidemiol Infect ; 147: e214, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-31364548

RESUMO

Although anorectal Chlamydia trachomatis (CT) infections are frequently diagnosed in men who have sex with men (MSM) and women, the reason for this infection often remains unexplained, as anal sex is not always reported. Oropharyngeal infections inoculating the gastrointestinal (GI) tract may contribute to anorectal-CT infections, as evidence in animals suggests that chlamydia bacteria undergo GI passage; however, no evidence exists in humans. Longitudinal patient clinic-registry data from MSM (n = 17 125) and women (n = 4120) from two Dutch sexually transmitted infection clinics were analysed. When adjusting for confounding socio-demographics, co-infections and risk behaviour, previous (from 3 weeks up to 24 months) oropharyngeal CT was not a risk factor for subsequent anorectal CT in women (odds ratio (OR) 0.46; 95% confidence interval (CI) 0.18-1.18; P = 0.11) and MSM (OR 1.33; 95% CI 0.86-2.07; P = 0.204). Despite the large dataset, the numbers did not allow for the estimation of risk in specific subgroups of interest. The role of the GI tract cannot be excluded with this epidemiological study, but the impact of preceding oropharyngeal CT on anorectal-CT infection is likely limited.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Infecções por Chlamydia/epidemiologia , Coinfecção/epidemiologia , Doenças Transmissíveis/epidemiologia , Orofaringe/microbiologia , Proctite/epidemiologia , Adulto , Fatores Etários , Análise de Variância , Chlamydia trachomatis/isolamento & purificação , Coinfecção/microbiologia , Feminino , Gonorreia/epidemiologia , Homossexualidade Masculina , Humanos , Estudos Longitudinais , Masculino , Análise Multivariada , Países Baixos/epidemiologia , Prevalência , Proctite/microbiologia , Estudos Retrospectivos , Fatores de Risco , Assunção de Riscos , Fatores Sexuais , Comportamento Sexual , Minorias Sexuais e de Gênero , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/epidemiologia
10.
Int J STD AIDS ; 30(6): 623-625, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30722752

RESUMO

Mycoplasma genitalium is an infection of increasing concern due to its potential to cause sequelae in the reproductive tract and the development of antimicrobial resistance. Its role as a cause of proctitis in people with high-risk sexual behaviour has not been properly defined yet but it seems to be less symptomatic than proctitis caused by Chlamydia trachomatis or Neisseria gonorrhoeae. We present a case of a man who has sex with men with proctitis associated with M. genitalium after excluding other infections known to cause STI proctitis.


Assuntos
Infecções por Mycoplasma/diagnóstico , Mycoplasma genitalium/isolamento & purificação , Proctite/diagnóstico , Proctite/microbiologia , Antibacterianos/uso terapêutico , Doxiciclina/uso terapêutico , Resistência Microbiana a Medicamentos , Infecções por HIV/complicações , Homossexualidade Masculina , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Mycoplasma/tratamento farmacológico , Proctite/tratamento farmacológico , Proctoscopia , Reto/diagnóstico por imagem , Infecções Sexualmente Transmissíveis/microbiologia , Resultado do Tratamento
13.
Sex Transm Dis ; 46(6): e68-e69, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30516724

RESUMO

The incidence of syphilis is increasing. Syphilitic proctitis involving the rectal mucosa often presents with pain on defecation, rectal bleeding, or ulceration. We present a case of asymptomatic syphilitic proctitis diagnosed upon a routine screening colonoscopy.


Assuntos
Infecções Assintomáticas , Proctite/diagnóstico , Sífilis/diagnóstico , Antibacterianos/uso terapêutico , Colonoscopia , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Proctite/tratamento farmacológico , Proctite/microbiologia , Proctite/patologia , Reto/diagnóstico por imagem , Reto/microbiologia , Reto/patologia , Sífilis/tratamento farmacológico , Sífilis/microbiologia , Sífilis/patologia
14.
Medicina (B Aires) ; 78(3): 207-210, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-29940550

RESUMO

From 2003 to date there has been a rising number of reports from developed countries on cases of lymphogranuloma venereum with anorectal localization in HIV-infected men who have sex with men. This localization differs from the classical inguinal abscesses which are typical of the disease in the tropics. The objective of this work is to document the presence of anorectal lymphogranuloma venereum in Buenos Aires and to describe its varied clinical manifestations. In the context of a systematic survey of rectal chlamydial infection, in just one trimester, eight cases of lymphogranuloma venereum caused by Chlamydia trachomatis biovar LGV were identified in HIV-infected men who have sex with men. The most frequent anorectal manifestations were pus, tenesmus, rectal urgency, and mucous or haemopurulent discharge. The proctitis was mostly mild or moderate and, in some cases, it was accompanied by perianal lesions. Given the great polymorphism and unspecificity of the clinical manifestations of the disease, we warn on the presence of this form of rectal lymphogranuloma venereum in our setting. If Chlamydia trachomatis is detected, it should be genotyped, not only for the correct diagnosis and treatment but also for epidemiological surveillance. Where genotyping is not available, the disease must be considered as caused by the LGV biovar and treated accordingly.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Chlamydia trachomatis/genética , Linfogranuloma Venéreo/diagnóstico , Proctite/diagnóstico , Minorias Sexuais e de Gênero , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Adulto , Humanos , Linfogranuloma Venéreo/microbiologia , Masculino , Polimorfismo Genético , Proctite/microbiologia , Estudos Prospectivos
15.
Medicina (B.Aires) ; 78(3): 207-210, jun. 2018. tab
Artigo em Espanhol | LILACS | ID: biblio-954980

RESUMO

Desde 2003, en los países desarrollados han aumentado las comunicaciones sobre casos de linfogranuloma venéreo con cuadros clínicos diferentes de la forma inguinal clásica. Las presentaciones anorrectales, hasta hace poco atípicas, predominan en hombres infectados por HIV que tienen sexo con hombres. El objetivo de este trabajo es informar sobre la presencia de esta infección en la Ciudad Autónoma de Buenos Aires y describir sus variadas manifestaciones clínicas. En el contexto de una pesquisa sistemática de la infección rectal por clamidias, en apenas un trimestre fueron identificados ocho casos de linfogranuloma venéreo por Chlamydia trachomatis biovar LGV en hombres HIV positivos que tienen sexo con hombres. Las manifestaciones anorrectales más frecuentes fueron pujo, tenesmo, urgencia evacuatoria y secreción mucosa o hemopurulenta. En su mayoría presentaban proctitis leve o moderada, acompañada en algunos casos de lesiones perianales. Dados el polimorfismo y la inespecificidad de las manifestaciones clínicas del linfogranuloma venéreo rectal, se advierte sobre la circulación de esta infección en nuestro medio. En caso de detectar Chlamydia trachomatis, es importante genotipificarla para el correcto diagnóstico y tratamiento de la enfermedad y también para su vigilancia epidemiológica. Si la genotipificación no es posible, se debe considerar el caso como producido por el biovar LGV y aplicar el tratamiento correspondiente.


From 2003 to date there has been a rising number of reports from developed countries on cases of lymphogranuloma venereum with anorectal localization in HIV-infected men who have sex with men. This localization differs from the classical inguinal abscesses which are typical of the disease in the tropics. The objective of this work is to document the presence of anorectal lymphogranuloma venereum in Buenos Aires and to describe its varied clinical manifestations. In the context of a systematic survey of rectal chlamydial infection, in just one trimester, eight cases of lymphogranuloma venereum caused by Chlamydia trachomatis biovar LGV were identified in HIV-infected men who have sex with men. The most frequent anorectal manifestations were pus, tenesmus, rectal urgency, and mucous or haemopurulent discharge. The proctitis was mostly mild or moderate and, in some cases, it was accompanied by perianal lesions. Given the great polymorphism and unspecificity of the clinical manifestations of the disease, we warn on the presence of this form of rectal lymphogranuloma venereum in our setting. If Chlamydia trachomatis is detected, it should be genotyped, not only for the correct diagnosis and treatment but also for epidemiological surveillance. Where genotyping is not available, the disease must be considered as caused by the LGV biovar and treated accordingly.


Assuntos
Humanos , Masculino , Adulto , Proctite/diagnóstico , Linfogranuloma Venéreo/diagnóstico , Chlamydia trachomatis/genética , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Minorias Sexuais e de Gênero , Polimorfismo Genético , Proctite/microbiologia , Linfogranuloma Venéreo/microbiologia , Estudos Prospectivos , Infecções Oportunistas Relacionadas com a AIDS/microbiologia
16.
Rev Esp Enferm Dig ; 110(6): 410, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29722270

RESUMO

Lymphogranuloma venereum (LGV) is a condition caused by invasive serovars of Chlamydia trachomatis. The classical inguinal presentation that is characterized by the development of transient genital ulcer(s) and inguinal or femoral lymphadenopathy has decreased in our environment. At present, infection by this bacterium has emerged as an important cause of proctitis and proctocolitis in men who have sex with other men. We report the case of a homosexual man with acute proctitis that was complicated by a perirectal abscess secondary to a Chlamydia trachomatis infection.


Assuntos
Abscesso/diagnóstico , Linfogranuloma Venéreo/diagnóstico , Proctite/microbiologia , Abscesso/complicações , Diagnóstico Diferencial , Humanos , Linfogranuloma Venéreo/complicações , Masculino , Pessoa de Meia-Idade , Proctite/diagnóstico
17.
Int J STD AIDS ; 29(11): 1133-1135, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29749879

RESUMO

Lymphogranuloma venereum (LGV) is caused by L1, L2 and L3 serovars of Chlamydia trachomatis. The anorectal syndrome caused by LGV is often misdiagnosed as inflammatory bowel disease and may rarely lead to stricture formation. Recurrent stricture formation, despite adequate LGV treatment, has not to our knowledge, previously been reported.


Assuntos
Chlamydia trachomatis/isolamento & purificação , Colite Ulcerativa/diagnóstico , Soropositividade para HIV , Homossexualidade Masculina , Linfogranuloma Venéreo/complicações , Proctite/microbiologia , Sigmoidoscopia , Chlamydia trachomatis/genética , Humanos , Linfogranuloma Venéreo/patologia , Masculino , Pessoa de Meia-Idade , Técnicas de Amplificação de Ácido Nucleico , Reação em Cadeia da Polimerase , Proctite/patologia
18.
Int J Infect Dis ; 71: 9-13, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29608959

RESUMO

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.


Assuntos
Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/tratamento farmacológico , Gonorreia/diagnóstico , Gonorreia/tratamento farmacológico , Homossexualidade Masculina , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/tratamento farmacológico , Adulto , Canal Anal/microbiologia , Antibacterianos/uso terapêutico , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/microbiologia , Feminino , Gonorreia/epidemiologia , Gonorreia/microbiologia , Humanos , Masculino , Testes de Sensibilidade Microbiana , Paris/epidemiologia , Prevalência , Proctite/epidemiologia , Proctite/microbiologia , Reto/microbiologia , Estudos Retrospectivos , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/microbiologia
19.
Sex Transm Dis ; 45(8): 522-526, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29465653

RESUMO

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.


Assuntos
Anti-Infecciosos/uso terapêutico , Gonorreia/epidemiologia , Gonorreia/microbiologia , Infecções por Mycoplasma/microbiologia , Mycoplasma genitalium/isolamento & purificação , Proctite/microbiologia , Doenças Retais/microbiologia , Adulto , Azitromicina/uso terapêutico , Chlamydia trachomatis/isolamento & purificação , Coinfecção , Gonorreia/tratamento farmacológico , Homossexualidade Masculina , Humanos , Masculino , Moxifloxacina/uso terapêutico , Infecções por Mycoplasma/tratamento farmacológico , Infecções por Mycoplasma/epidemiologia , Neisseria gonorrhoeae/isolamento & purificação , Pristinamicina/uso terapêutico , Proctite/tratamento farmacológico , Proctite/epidemiologia , Doenças Retais/tratamento farmacológico , Doenças Retais/epidemiologia , Comportamento Sexual , Minorias Sexuais e de Gênero , Vitória/epidemiologia , Adulto Jovem
20.
Gut ; 67(1): 97-107, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28438965

RESUMO

OBJECTIVE: Radiation proctitis (RP) is a complication of pelvic radiotherapy which affects both the host and microbiota. Herein we assessed the radiation effect on microbiota and its relationship to tissue damage using a rectal radiation mouse model. DESIGN: We evaluated luminal and mucosa-associated dysbiosis in irradiated and control mice at two postradiation time points and correlated it with clinical and immunological parameters. Epithelial cytokine response was evaluated using bacterial-epithelial co-cultures. Subsequently, germ-free (GF) mice were colonised with postradiation microbiota and controls and exposed to radiation, or dextran sulfate-sodium (DSS). Interleukin (IL)-1ß correlated with tissue damage and was induced by dysbiosis. Therefore, we tested its direct role in radiation-induced damage by IL-1 receptor antagonist administration to irradiated mice. RESULTS: A postradiation shift in microbiota was observed. A unique microbial signature correlated with histopathology. Increased colonic tumor necrosis factor (TNF)α, IL-1ß and IL-6 expression was observed at two different time points. Adherent microbiota from RP differed from those in uninvolved segments and was associated with tissue damage. Using bacterial-epithelial co-cultures, postradiation microbiota enhanced IL-1ß and TNFα expression compared with naïve microbiota. GF mice colonisation by irradiated microbiota versus controls predisposed mice to both radiation injury and DSS-induced colitis. IL-1 receptor antagonist administration ameliorated intestinal radiation injury. CONCLUSIONS: The results demonstrate that rectal radiation induces dysbiosis, which transmits radiation and inflammatory susceptibility and provide evidence that microbial-induced radiation tissue damage is at least in part mediated by IL-1ß. Environmental factors may affect the host via modifications of the microbiome and potentially allow for novel interventional approaches via its manipulation.


Assuntos
Colite/etiologia , Citocinas/biossíntese , Disbiose/etiologia , Microbioma Gastrointestinal/efeitos da radiação , Lesões por Radiação/microbiologia , Animais , Técnicas de Cocultura , Colite/imunologia , Colite/microbiologia , Suscetibilidade a Doenças , Disbiose/imunologia , Disbiose/microbiologia , Transplante de Microbiota Fecal , Fezes/microbiologia , Feminino , Vida Livre de Germes , Mucosa Intestinal/imunologia , Mucosa Intestinal/microbiologia , Camundongos Endogâmicos C57BL , Proctite/etiologia , Proctite/imunologia , Proctite/microbiologia , Lesões por Radiação/imunologia , Reto/imunologia , Reto/microbiologia , Reto/efeitos da radiação
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