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Etiology of clinical proctitis among men who have sex with men.
Abstract
In this retrospective review of cases of clinical proctitis, we identified the frequency of common sexually transmitted diseases (STDs) among men who have sex with men on the basis of reports from the municipal STD clinic in San Francisco. Of note, gonorrhea and chlamydia were the most common STDs, followed by herpes and syphilis. Current STD treatment guidelines recommend empiric treatment for gonorrhea and chlamydia, but treatment for herpes should also be considered. The implications for human immunodeficiency virus (HIV) transmission are also discussed.
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“Acute proctitis among persons who have anal exposure through oral, genital, or digital contact is usually sexually acquired (1382,1388).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [1388]
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Sexually Transmitted Infections Treatment Guidelines, 2021
Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, C. M., Muzny, C. A., Park, I., Reno, H., Zenilman, J. M., & Bolan, G. A. (2021) · MMWR. Recommendations and Reports · doi:10.15585/mmwr.rr7004a1 · Cited by 3,018
Sexually transmitted diseases treatment guidelines
Burstein, G. R., & Workowski, K. (2003) · Current Opinion in Pediatrics · doi:10.1097/00008480-200308000-00006 · Cited by 2,077
Sexually Transmitted Diseases Treatment Guidelines, 2010
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“MSM was recently discussed in this journal [1].”
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Bhaijee, F., Subramony, C., Tang, S., & Pepper, D. J. (2011) · Pathology Research International · doi:10.4061/2011/247923 · Cited by 98
“In HIV infection and men who have sex with men, proctitis may occur secondary to HSV, Neisseria gonorrhea, Chlamydia trachomatis, or Treponema pallidum infection [29].”
Sexually transmitted proctitis
Hamlyn, E., & Taylor, C. (2006) · Postgraduate Medical Journal · doi:10.1136/pmj.2006.048488 · Cited by 91
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“As per current standard of care, all MSM who reported receptive anal sex within 6 months before their clinic visit were screened for N. gonorrhoeae and C. trachomatis by TMA (Aptima Combo2; Gen-Probe, San Diego), validated by the San Francisco Department of Public Health Laboratory for rectal swabs.21 MSM with rectal…”
BackgroundInfluentialInfectious Proctitis: When to Suspect It Is Not Inflammatory Bowel Disease
Hoentjen, F., & Rubin, D. T. (2011) · Digestive Diseases and Sciences · doi:10.1007/s10620-011-1935-0 · Cited by 87
“Importantly, no identifiable infectious source is found in 45% of cases [5].”
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Heterosexual Anal Sex Activity in the Year After an STD Clinic Visit
Tian, L. H., Peterman, T. A., Tao, G., Brooks, L. C., Metcalf, C. A., Malotte, C. K., Paul, S. M., & Douglas, J. M. (2008) · Sexually Transmitted Diseases · doi:10.1097/olq.0b013e318181294b · Cited by 67
2016 United Kingdom national guideline on the sexual health care of men who have sex with men
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The etiology of infectious proctitis in men who have sex with men differs according to HIV status.
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Haemorrhoids, rectal prolapse, anal fissure, peri-anal fistulae and sexually transmitted diseases
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2014 UK national guideline for the management of anogenital herpes
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“A retrospective review in the USA found that 16% of MSM with proctitis had HSV detected by culture methods, and that 3% had herpes in addition to another rectal STI.(9) .”
BackgroundSexually Transmitted Infections
Smith, L., & Angarone, M. (2015) · Urologic Clinics of North America · doi:10.1016/j.ucl.2015.06.004 · Cited by 61
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“Pallidum.(14,162,174,175) Patients with proctitis should be tested for HIV, hepatitis C, and hepatitis A & B if non-immune, as per BASHH guidelines.”
BackgroundSexually Transmitted Infections as a Cause of Proctitis in Men Who Have Sex with Men
Davis, T. W., & Goldstone, S. E. (2009) · Diseases of the Colon & Rectum · doi:10.1007/dcr.0b013e31819ad537 · Cited by 48
“Although this series is small and cannot determine the true prevalence of STIs in MSM, the findings are similar to other series.(5,6) We feel that clinicians treating MSM for anorectal disease must become versed in diagnosis and treatment of STI causes of proctitis or know where to refer patients for proper evaluation.”
ResultRectal Lymphogranuloma Venereum, France
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“With respect to HIV-positive MSM, use of MDMA has been associated with higher viral loads, more rapid HIV progression, and increased neurological damage (Seattle & King County Public Health, 2004).”
BackgroundInfluentialGastroenteritis in Men Who Have Sex With Men in Seattle, Washington, 2017–2018
Newman, K. L., Newman, G. S., Cybulski, R. J., & Fang, F. C. (2019) · Clinical Infectious Diseases · doi:10.1093/cid/ciz783 · Cited by 37
Nonclassical Pathogens as Causative Agents of Proctitis in Men who Have Sex With Men
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Cytomegalovirus Proctitis: A Rare and Disregarded Sexually Transmitted Disease
STUDEMEISTER, A. E. (2011) · Sexually Transmitted Diseases · doi:10.1097/olq.0b013e31821a5a90 · Cited by 30
Herpes Simplex Proctitis Mimicking Inflammatory Bowel Disease in a Teenaged Male
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“Depending on the history of patients with urethritis, additional smears from the pharynx and from the anal region are necessary. Proctitis is a condition that is not uncommon among MSM and greatly increases the risk of HIV acquisition by up to 9-fold [”
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“Proctitis was defined as the presence of ≥5 polymorphonuclear cells per high power field on a rectal Gram stain [10].”
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Sentinel Surveillance of Rectal Chlamydia and Gonorrhea Among Males—San Francisco, 2005–2008
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Condyloma and Other Infections Including Human Immunodeficiency Virus
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Gardnerella vaginalis and Mollicute detection in rectal swabs from men who have sex with men
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“This is important for men in the MSM population since they are more likely to have a higher number of lifetime sexual partners and so are more likely to transmit undetected and unrecognised infections.(5,6)”
BackgroundNeisseria gonorrhoeae (Gonorrhea)
Marrazzo, J. M., & Apicella, M. A. (2015) · Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases · doi:10.1016/b978-1-4557-4801-3.00214-9 · Cited by 20
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Clinical Effectiveness Group (British Association for Sexual Health and HIV)
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Gastrointestinal Disorders in HIV
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Symptomatic sexually transmitted proctitis in men who have sex with men
Pinto-Sander, N., Parkes, L., Fitzpatrick, C., & Richardson, D. (2019) · Sexually Transmitted Infections · doi:10.1136/sextrans-2018-053936 · Cited by 16
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Sexually transmitted infections: what's new?
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Infectious proctitis: what every gastroenterologist needs to know
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“Rectal chlamydia infection has been shown to account for approximately 20% of all IP cases, frequently in association with other agents [5].”
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Infections of the Gastrointestinal Tract
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Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men
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“P that cause proctitis include Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, and herpes simplex virus (1).”
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Allan‐Blitz, L., Beaird, O. E., Dry, S., Kaneshiro, M., & Klausner, J. D. (2018) · Sexually Transmitted Diseases · doi:10.1097/olq.0000000000000955 · Cited by 11
“One review of proctitis cases among men who have sex with men found syphilis to be the causative disease among 2% of cases.(7) Rectal involvement as a result of syphilis can occur in either primary or secondary infection.”
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Costales, J. K., Dong, E. Y., Wu, B. U., & Nomura, J. H. (2021) · Journal of General Internal Medicine · doi:10.1007/s11606-020-06414-9 · Cited by 11
“often caused by organisms that are sexually transmitted, most commonly Neisseria gonorrhoeae (30%) and Chlamydia trachomatis (19%), followed by herpes simplex virus 2 (16%) and syphilis (2%).(22,23) Other rare causes of infectious proctitis include amebiasis and Mycoplasma genitalium.”
BackgroundProctitis in gay and bisexual men. Are microscopy and proctoscopy worthwhile?
Mwasakifwa, G. E., Nugent, C., & Varma, R. (2020) · Sexually Transmitted Infections · doi:10.1136/sextrans-2019-054197 · Cited by 10
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“Anorectal STIs are common in MSM and may increase the risk of HIV transmission 63–65 (figure 1 ).”
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Infections of the Gastrointestinal Tract
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Proctitis: a glance beyond inflammatory bowel diseases
Rizza, S., Mistrangelo, M., Ribaldone, D. G., Morino, M., Astegiano, M., Saracco, G. M., & Pellicano, R. (2020) · Minerva Gastroenterologica e Dietologica · doi:10.23736/s1121-421x.20.02670-7 · Cited by 6
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Proctitis Caused by Mycobacterium avium-intracellulare in an HIV-Infected Patient
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“Co-infections were not uncommon, 10% of the patients with infectious proctitis tested positive for multiple pathogens [4].”
BackgroundMechanisms, management and prevention of anorectal sexually transmitted infections
Latt, P. M., Kong, F. Y. S., Khosropour, C. M., Lee, M. J., Pasricha, S., Hybiske, K., & Chow, E. P. F. (2026) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-026-01232-6 · Cited by 4
Etiologies of Proctitis at a Sexual Health Clinic in Seattle, Washington From 2011 to 2021
Kumbhakar, R. G., Barbee, L. A., Berzkalns, A., Hermann, S., Ramchandani, M. S., Golden, M. R., & Dombrowski, J. C. (2022) · Sexually Transmitted Diseases · doi:10.1097/olq.0000000000001696 · Cited by 4
“A defining review described the microbiologic etiologies of proctitis among symptomaticMSM in an STD clinic in San Francisco from 2001 to 2002; in that cohort, 55% had an identified pathogen, with the majority of cases due to GC (20%) followed by CT (11%) and HSV (13%).(6) To our knowledge, no updated reports on proct…”
BackgroundResultInfluentialSeparating Infectious Proctitis from Inflammatory Bowel Disease—A Common Clinical Conundrum
Hall, R., Patel, K., Poullis, A. P., Pollok, R., & Honap, S. (2024) · Microorganisms · doi:10.3390/microorganisms12122395 · Cited by 4
“Syphilis proctitis is a rare presentation of syphilis infection and only causes 1% of infective proctitis overall [97,98].”
Proktitis – aus gastroenterologischer Sicht
Escher, M., Herrlinger, K. R., & Stange, E. F. (2010) · coloproctology · doi:10.1007/s00053-010-0130-7 · Cited by 4
Advances in sexually transmitted infections of the gastrointestinal tract
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“gonorrhea were seen in up to one-third of MSM who present with any rectal symptoms”
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Entamoeba histolytica‐associated proctitis and ileitis mimicking Crohn's disease—A case report
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The Great Mimicker Gets Caught: A Rare Case of Syphilis in the Gastrointestinal Tract
Lopez, C. C., Herrera-Gonzalez, S., Shamoon, D., Dacosta, T. J., & Bains, Y. (2024) · Cureus · doi:10.7759/cureus.59222 · Cited by 3
“Syphilis is the cause of sexually transmitted proctitis in only 1% of MSM and transgender females [1].”
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A Rare Case of Disseminated Mycobacterium avium-intracellulare Presenting as Proctitis
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CT findings of proctitis in two patients with Mpox
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“In both patients, common infectious causes of proctitis including sexually transmitted infections (STIs) such as gonorrhea, chlamydia, syphilis, and HPV were ruled out [6, 11].”
BackgroundDermatologic Complications of HIV
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Plasmablastic Lymphoma Masquerading as Perianal Abscess in a Homosexual Man
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“who have anal intercourse, sexually transmitted infections also need to be considered, and organisms associated with sexually transmitted proctitis have been reviewed.(5,6) More recently, there has been an increase in the incidence of unprotected anal intercourse among homosexual men with an associated increased incid…”
BackgroundHistologic mimics of inflammatory bowel disease
Zhao, L., & Hart, J. A. L. (2014) · Seminars in Diagnostic Pathology · doi:10.1053/j.semdp.2014.02.003 · Cited by 1
A couplet: a case of anal ulceration and another of inguinal swelling
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Alves, J., Azevedo, J., Santo, I., & Borrego, M. J. (2016) · Journal of the Portuguese Society of Dermatology and Venereology · doi:10.29021/spdv.74.1.516 · Cited by 1
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Lv, L., Liu, G., Jie, X., Luo, J., Peng, L., Ding, Y., & Shi, W. (2024) · Revista Española de Enfermedades Digestivas · doi:10.17235/reed.2024.10334/2024 · Cited by 1
Nanomedicine in the development of vaccines against Herpesviridae: a narrative review
Lee, D. H.-Y., Lee, W., & Bach, H. (2025) · Nanomedicine · doi:10.1080/17435889.2025.2587714 · Cited by 1
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Ng, B., Rutherford, G. W., Broad, A. L., & Moore, D. M. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006492.pub2 · Cited by 1
RetractedKnight, D. A. (2008) · Elsevier eBooks · doi:10.1016/b978-141603000-3.10029-2 · Cited by 1
Acute Cytomegalovirus Proctitis in an Immunocompetent Man After Receptive Anal Intercourse
Huth, R. G. (2010) · Infectious Diseases in Clinical Practice · doi:10.1097/ipc.0b013e3181eaf9e0 · Cited by 1
(2011) · coloproctology · doi:10.1007/s00053-011-0164-5 · Cited by 1
Non-neoplastic diseases of the small and large intestines
Moskaluk, C. A. (2015) · Cambridge University Press eBooks · doi:10.1017/9781139137201.027 · Cited by 1
Halioua, B., Janier, M., Dupin, N., Derancourt, C. H., Caumes, É., & Bouscaratet, F. (2006) · Annales de Dermatologie et de Vénéréologie · doi:10.1016/s0151-9638(06)71029-8 · Cited by 1
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Looze, D. A. D. (2007) · Journal Africain d Hépato-Gastroentérologie · doi:10.1007/s12157-007-0002-0
“Néanmoins, la cause n’est pas établie dans presque la moitié des cas, selon des séries américaines [4].”
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Prod’hom, G., & Billé, J. (2009) · Springer eBooks · doi:10.1007/978-3-540-69419-9_11
Anorectal manifestations in AIDS patients
Looze, D. A. D. (2007)
HIV-Associated Anorectal Lymphogranuloma Venereum: An Emerging Epidemic
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Cazalilla, M. S., & Aguilar, F. C. (2008) · Medicine - Programa de Formación Médica Continuada Acreditado · doi:10.1016/s0211-3449(08)72939-4
Protocolo diagn?stico y tratamiento de las rectitis en homosexuales
Molina, F., & Ruiz, C. M. (2006) · Medicine - Programa de Formación Médica Continuada Acreditado · doi:10.1016/s0211-3449(06)74227-8
Metadata
- Authors
- Klausner, J. D., Kohn, R., & Kent, C.
- Affiliations
- University of California, San Francisco (US)
- San Francisco Department of Public Health (US)
- Corresponding author
- Klausner, Jeffrey D.
- ORCID
- Klausner, Jeffrey D.
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2004-01-15
- Volume
- 38
- Issue
- 2
- Pages
- 300-302
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2117345740
- Cited by
- 129
- References
- 8
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 6 · 2023: 8 · 2022: 3 · 2021: 7 · 2020: 4 · 2019: 5 · 2018: 5 · 2017: 5 · 2016: 5 · 2015: 5 · 2014: 3 · 2013: 4 · 2012: 3
- FWCI
- 4.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Infectious Diseases › Herpesvirus Infections and Treatments
- Keywords
- proctitis, men who have sex with men, sexually transmitted infections, gonorrhea, chlamydia, herpes, syphilis, empirical treatment, HIV transmission
- MeSH terms
- Adolescent, Adult, Chlamydia Infections, Gonorrhea, HIV, Humans, Male, Middle Aged, Proctitis, Sexually Transmitted Diseases, Syphilis, Homosexuality, Male
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