Ferzacca Elizabeth, Barbieri Andrea, Barakat Lydia, Olave Maria C, Dunne Dana
Yale School of Medicine, New Haven, Connecticut, USA.
Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA.
Open Forum Infect Dis. 2021 Mar 29;8(6):ofab157. doi: 10.1093/ofid/ofab157. eCollection 2021 Jun.
Syphilis infections are increasing globally. Lower gastrointestinal syphilis (LGIS) is a rare manifestation of early syphilis transmitted through anal sexual contact. Misdiagnosis of LGIS as inflammatory bowel disease may result from clinician underawareness.
We searched the literature for articles describing cases of LGIS, and identified additional cases diagnosed within our institution. Data were extracted from the articles and medical records and analyzed to provide a summative account.
Fifty-four cases of LGIS were identified in 39 articles published between 1958 and 2020. Eight additional cases were diagnosed at our institution between 2011 and 2020, totaling 62 cases. All cases were described in men and transwomen aged 15-73 years. Fifty (93%) individuals reported having sex with men. In 26 cases (52%), the individuals were human immunodeficiency virus (HIV) coinfected. LGIS presented most commonly with hematochezia (67%) and anal pain (46%). The most common physical examination findings were rectal mass (38%), lymphadenopathy (31%), and rash (26%). Nontreponemal titers ranged from 1:2 to 1:1024. Of the 52 cases in which endoscopy was reported, 22 (42%) showed anorectal mass and 18 (35%) showed anorectal ulcer. In 44 cases (75%), histopathology revealed a chronic inflammatory infiltrate with a prominent lymphocyte component (45%) and/or plasma cells (36%). Seventy-eight percent of specimens to which a tissue stain was applied were positive for spirochetes.
LGIS should be suspected in men and transwomen presenting with a lower gastrointestinal symptom or mucosal abnormality. A sexual history must be elicited and guide testing. Misdiagnosis can delay treatment and threatens patient and public health.
梅毒感染在全球范围内呈上升趋势。下消化道梅毒（LGIS）是通过肛交传播的早期梅毒的一种罕见表现形式。临床医生认识不足可能导致将LGIS误诊为炎症性肠病。
我们检索文献以查找描述LGIS病例的文章，并确定在我们机构内诊断出的其他病例。从文章和病历中提取数据并进行分析以提供总结性描述。
在1958年至2020年发表的39篇文章中确定了54例LGIS病例。2011年至2020年期间在我们机构又诊断出8例，共计62例。所有病例均为年龄在15至73岁的男性和变性女性。50例（93%）个体报告有男男性行为。26例（52%）个体合并感染人类免疫缺陷病毒（HIV）。LGIS最常见的表现为便血（67%）和肛门疼痛（46%）。最常见的体格检查发现是直肠肿物（38%）、淋巴结病（31%）和皮疹（26%）。非梅毒螺旋体抗体滴度范围为1:2至1:1024。在报告进行内镜检查的52例病例中，22例（42%）显示肛门直肠肿物，18例（35%）显示肛门直肠溃疡。44例（75%）病例的组织病理学显示慢性炎症浸润，其中淋巴细胞成分突出（45%）和/或浆细胞（36%）。应用组织染色检查标本的78%螺旋体呈阳性。
对于出现下消化道症状或黏膜异常的男性和变性女性应怀疑LGIS。必须询问性病史并指导检测。误诊会延误治疗并威胁患者和公众健康。
