STI Outpatient Clinic, Cluster Infectious Diseases, Health Service Amsterdam, Amsterdam, The Netherlands.
Department of Dermatology, Amsterdam Institute for Infection and Immunity (AII), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
J Eur Acad Dermatol Venereol. 2021 Jul;35(7):1434-1443. doi: 10.1111/jdv.17269. Epub 2021 May 31.
This guideline intents to offer guidance on the diagnosis and management of patients with gastrointestinal symptoms and a suspected sexually transmitted cause. Proctitis is defined as an inflammatory syndrome of the anal canal and/or the rectum. Infectious proctitis can be sexually transmitted via genital-anal mucosal contact, but some also via digital contact and toys. Neisseria gonorrhoeae, Chlamydia trachomatis (including lymphogranuloma venereum), Treponema pallidum and herpes simplex virus are the most common sexually transmitted anorectal pathogens. Shigellosis can be transferred via oral-anal contact and may lead to proctocolitis or enteritis. Although most studies on these infections have concentrated on men who have sex with men (MSM), women having anal intercourse may also be at risk. A presumptive clinical diagnosis of proctitis can be made when there are symptoms and signs, and a definitive diagnosis when the results of laboratory tests are available. The symptoms of proctitis include anorectal itching, pain, tenesmus, bleeding, constipation and discharge in and around the anal canal. The majority of rectal chlamydia and gonococcal infections are asymptomatic and can only be detected by laboratory tests. Therefore, especially when there is a history of receptive anal contact, exclusion of anorectal infections is generally indicated as part of standard screening for sexually transmitted infections (STIs). Condom use does not guarantee protection from STIs, which are often spread without penile penetration. New in this updated guideline is: (i) lymphogranuloma venereum proctitis is increasingly found in HIV-negative MSM, (ii) anorectal Mycoplasma genitalium infection should be considered in patients with symptomatic proctitis after exclusion of other common causations such N. gonorrhoeae, C. trachomatis, syphilis and herpes, (iii) intestinal spirochetosis incidentally found in colonic biopsies should not be confused with syphilis, and (iv) traumatic causes of proctitis should be considered in sexually active patients.
本指南旨在为有胃肠道症状且疑似性传播病因的患者提供诊断和管理方面的指导。直肠炎定义为肛门直肠黏膜的炎症综合征。感染性直肠炎可通过生殖器-肛门黏膜接触传播，但也可通过手指接触和玩具传播。淋病奈瑟菌、沙眼衣原体（包括性病淋巴肉芽肿）、苍白螺旋体和单纯疱疹病毒是最常见的性传播性肛门直肠病原体。志贺菌病可通过口腔-肛门接触传播，并可导致直肠结肠炎或肠炎。虽然这些感染的大多数研究都集中在男男性行为者（MSM）上，但进行肛交的女性也可能有风险。当有症状和体征时，可以做出直肠炎的临床诊断，当有实验室检查结果时可以做出明确诊断。直肠炎的症状包括肛门直肠瘙痒、疼痛、里急后重、出血、便秘和肛门周围的分泌物。大多数直肠衣原体和淋病感染是无症状的，只能通过实验室检查发现。因此，特别是当有接受性肛门接触史时，通常需要排除肛门直肠感染，作为性传播感染（STI）标准筛查的一部分。使用避孕套并不能保证免受 STI 的感染，这些感染通常在没有阴茎穿透的情况下传播。本更新指南的新内容包括：（i）在 HIV 阴性的 MSM 中越来越多地发现性病淋巴肉芽肿性直肠炎，（ii）在排除淋病奈瑟菌、沙眼衣原体、梅毒和疱疹等其他常见病因后，有症状直肠炎患者应考虑生殖道支原体感染，（iii）偶然在结肠活检中发现的肠道螺旋体病不应与梅毒混淆，（iv）应考虑有性生活的患者的直肠炎创伤性病因。
