Baker R W, Peppercorn M A
Pharmacotherapy. 1982 Jan-Feb;2(1):32-42. doi: 10.1002/j.1875-9114.1982.tb03170.x.
Certain enteric ailments are particularly common among homosexual men. They are primarily infectious diseases and include not only such common venereal diseases as gonorrhea and syphilis but also infections not usually regarded as being sexually transmitted. Among the latter are shigellosis, salmonellosis, giardiasis, and amebiasis. Patients' symptoms are non-specific and seldom helpful in diagnosing particular diseases. The practitioner must be prepared to identify a number of infections with similar presentations that may occur singly or together in gay men. Gonorrhea is probably the most common bacterial infection in gay men. Carriage rates as high as 50% have been reported, and extra-genital carriage is common; this necessitates culturing the urethra, rectum, and pharynx. Procaine penicillin G is the treatment of choice for most patients; spectinomycin is probably the drug of choice in penicillin-sensitive patients. In contrast to other venereal diseases, syphilis may have a characteristic protoscopic presentation. Benzathine penicillin G is the treatment of choice for most patients. Lymphogranuloma venereum causes penile lesions and inguinal lymphadenitis in heterosexual men, whereas homosexual men are more prone to proctitis. The disease may mimic Crohn's disease. Recommended treatment includes tetracycline or sulfamethoxazole-trimethoprim. Shigellosis usually presents as an acute diarrheal illness. Patients generally require only supportive treatment with fluids. Herpes simplex viral infection is difficult to diagnose and has several different presentations, including lumbosacral radiculomyelopathy. Symptomatic treatment with sitz baths, anesthetic ointment, and analgesics is recommended. Venereal warts are believed to be caused by the same virus that causes verrucous warts; they are usually found in the anal canal or around the anal orifice. They are commonly treated with 25% podophyllin solution. Parasitic infections include giardiasis, amebiasis, and pinworm infections. Metronidazole may be used in the treatment of symptomatic giardiasis and amebiasis, but it is not approved for the former indication; quinacrine is approved for giardiasis. Pinworm infestation may be treated with pyrantel pamoate or mebendazole. Cure of enteric diseases in homosexual men must be documented.
某些肠道疾病在男同性恋者中尤为常见。这些疾病主要是传染病，不仅包括淋病和梅毒等常见性病，还包括通常不被视为性传播的感染。后者包括志贺菌病、沙门菌病、贾第虫病和阿米巴病。患者的症状不具特异性，对诊断特定疾病帮助不大。从业者必须准备好识别男同性恋者中可能单独或同时出现的多种具有相似表现的感染。淋病可能是男同性恋者中最常见的细菌感染。据报道，携带率高达50%，生殖器外携带很常见；这就需要对尿道、直肠和咽部进行培养。普鲁卡因青霉素G是大多数患者的首选治疗药物；壮观霉素可能是对青霉素敏感患者的首选药物。与其他性病不同，梅毒可能有特征性的肉眼可见表现。苄星青霉素G是大多数患者的首选治疗药物。性病性淋巴肉芽肿在异性恋男性中会导致阴茎病变和腹股沟淋巴结炎，而男同性恋者更容易患直肠炎。这种疾病可能类似克罗恩病。推荐的治疗方法包括四环素或复方新诺明。志贺菌病通常表现为急性腹泻病。患者一般仅需补充液体进行支持治疗。单纯疱疹病毒感染难以诊断，有几种不同的表现形式，包括腰骶神经根脊髓病。建议采用坐浴、麻醉药膏和止痛药进行对症治疗。尖锐湿疣被认为是由导致疣状疣的同一种病毒引起的；它们通常出现在肛管或肛门开口周围。通常用25%的鬼臼树脂溶液进行治疗。寄生虫感染包括贾第虫病、阿米巴病和蛲虫感染。甲硝唑可用于治疗有症状的贾第虫病和阿米巴病，但未被批准用于前一种适应症；喹吖因被批准用于治疗贾第虫病。蛲虫感染可用噻嘧啶或甲苯达唑治疗。必须记录男同性恋者肠道疾病的治愈情况。
