Clinical Microbiology Department, GH Paris Saint-Joseph, 185, rue R. Losserand, 75014, Paris, France.
Department of Medical-Surgical Proctology, Léopold Bellan Institute, GH Paris Saint-Joseph, Paris, France.
Infection. 2022 Aug;50(4):933-940. doi: 10.1007/s15010-022-01766-2. Epub 2022 Feb 25.
Anoproctitis due to Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are Sexual Transmitted Infections (STIs) reported in MSM population. This study describes clinical and microbiological epidemiology of infective anoproctitis in MSM population.
All patients with symptomatic anoproctitis consulting at the proctology Institute of Saint-Joseph's Hospital, Paris, were included. Detection of CT/NG was performed by PCR GeneXpert and other STIs pathogens Mycoplasma sp., HSV, CMV and T. pallidum were detected by multiplex PCR Allplex (mPCR).
Symptoms most frequently reported were pain, rectal bleeding and purulent flow in 66%, 52% and 49% of cases, respectively. On the 311 rectal samples collected, 171 (55.2%) were positive to CT/NG. Among the 194 used for mPCR, 148 were positive to STIs pathogens (76.2%) including 106 samples (71.6%) positive in coinfections. Among NG infections, 22.6% of the strains were resistant to azithromycin and 26.8% to tetracyclines.
Anorectal infections in this MSM population showed a high prevalence of not only CT/NG but also other pathogens involved in STIs. The high level of coinfections confirms the requirement of accurate PCR tests to improve diagnosis. This study describing increasing antibiotic resistances for NG strains confirms the updating of international guidelines on antibiotic treatments recommendations.
沙眼衣原体（CT）和淋病奈瑟菌（NG）引起的肛门直肠炎是男男性行为者（MSM）人群中报告的性传播感染（STIs）。本研究描述了 MSM 人群中感染性肛门直肠炎的临床和微生物流行病学。
所有在巴黎圣约瑟夫医院肛肠病研究所就诊的有症状肛门直肠炎患者均被纳入研究。采用 PCR GeneXpert 检测 CT/NG，采用多重 PCR Allplex（mPCR）检测其他 STIs 病原体支原体、单纯疱疹病毒（HSV）、巨细胞病毒（CMV）和梅毒螺旋体。
报告的最常见症状分别为疼痛（66%）、直肠出血（52%）和脓性分泌物（49%）。在采集的 311 份直肠样本中，171 份（55.2%）对 CT/NG 呈阳性。在用于 mPCR 的 194 份样本中，148 份（76.2%）对 STIs 病原体呈阳性，包括 106 份（71.6%）合并感染的样本。NG 感染中，22.6%的菌株对阿奇霉素耐药，26.8%的菌株对四环素耐药。
在该 MSM 人群中，肛门直肠感染不仅 CT/NG 而且其他 STIs 相关病原体的患病率很高。高水平的合并感染证实了需要准确的 PCR 检测来改善诊断。本研究描述了 NG 菌株抗生素耐药性的增加，证实了更新国际抗生素治疗建议指南的必要性。
