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The incidence of infectious proctitis appears to be increasing in relation to unprotected sex in men who have sex with men (MSM). The typically involved pathogens are: <span class="elsevierStyleItalic">Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum</span> and <span class="elsevierStyleItalic">Herpes simplex</span>, although others have been also associated such as <span class="elsevierStyleItalic">Escherichia coli, Shigella, Campylobacter</span> and <span class="elsevierStyleItalic">Clostridium difficile</span>,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> which are clinically indistinguishable. This fact justifies taking adequate samples, even performing a biopsy if the condition does not improve with the prescribed treatment. Proctitis may occur less frequently due to non-infectious problems such as inflammatory bowel disease. There is also a high proportion (60–70%) of these patients who are asymptomatic carriers of these pathogens.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> We report a rare cause of proctitis.</p><p id="par0010" class="elsevierStylePara elsevierViewall">This was a 32-year-old patient without a medical history, who underwent an orchiectomy due to testicular torsion in 2012, who occasionally drinks alcohol and smokes 20 cigarettes a day. He went to the sexually transmitted diseases (STDs) unit because, after having had unprotected sex, presented with a lesion classified as chancre. A <span class="elsevierStyleItalic">T. pallidum</span> serology was performed, which proved positive for the current disease and was treated with penicillin G benzathine, 2 doses intramuscularly. At that time, HIV serology was positive, so it was referred to the hospital's infectious diseases consultation. During that appointment, the main symptoms were a feverish feeling, watery diarrhoea and weight loss. The initial HIV patient battery study was completed and treatment was initiated with a single-dose triple therapy (EVG/c<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>TDF<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>3TC). HIV viral load was 9,961,378<span class="elsevierStyleHsp" style=""></span>copies/ml, so an appointment was made in a month's time. After a month of therapy, the patient was feeling better overall, but had started to experience proctalgia together with both, anal and urethral purulent secretion, having resumed unprotected sex with other men at that time. A diagnosis of proctitis with a probable infectious aetiology was made. In order to study infectious agents, secretion samples were taken. Empirical therapy was then initiated with single dose ceftriaxone 1<span class="elsevierStyleHsp" style=""></span>g and single dose azithromycin 1.5<span class="elsevierStyleHsp" style=""></span>g, improving the patient's signs and symptoms. Subsequently, results about the growth of <span class="elsevierStyleItalic">Neisseria meningitidis</span> serogroup B were received, identified by mass spectrometry with Biotyper<span class="elsevierStyleSup">®</span> (Bruker Daltonics) and standard biochemistry (Vitek<span class="elsevierStyleSup">®</span> II; bioMérieux, Anglum Road, Hazelwood, MO, USA). Antimicrobial susceptibility profile was performed using the <span class="elsevierStyleItalic">E-test</span> method, being sensitive to tetracycline (MIC: 0.047<span class="elsevierStyleHsp" style=""></span>mg/l), cefotaxime (MIC: 0.125<span class="elsevierStyleHsp" style=""></span>mg/l), ciprofloxacin (MIC: 0.004<span class="elsevierStyleHsp" style=""></span>mg/l) and azithromycin (MIC: 0.75<span class="elsevierStyleHsp" style=""></span>mg/l).</p><p id="par0015" class="elsevierStylePara elsevierViewall">MSM patients with HIV infection experience STDs<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> more often and, of them, gonococcal infections are the most common,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> these being more symptomatic than those caused by other etiologic agents, allowing diagnosis and treatment in most cases. Also the fact of finding infectious proctitis, justifies changes in the patient's rectal mucosa, increasing the risk threshold of HIV acquisition.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleItalic">N. meningitidis</span> descriptions in cases of proctitis is limited in literature, representing only 8.7% of all <span class="elsevierStyleItalic">Neisseria</span> isolates in genitourinary samples,<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> being associated with sexual activity.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Isolates in the largest series studied were statistically associated with MSM practices.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Some authors question their pathogenic significance due to the small percentage of symptomatic patients with positive isolations; against this theory, significant histopathological changes have been observed in rectal mucosa of patients with <span class="elsevierStyleItalic">N. meningitidis</span> isolates, regardless of the time course of infection.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Escobar-Sevilla J, Hidalgo-Tenorio C, Navarro-Marí JM, Gutiérrez-Fernández J. Proctitis en varón con relaciones sexuales con hombres e infectado por el virus de la inmunodeficiencia humana. Med Clin (Barc). 2016;146:468–469.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infectious proctitis: when to suspect it is not inflammatory bowel disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. Hoetien" 1 => "D.T. 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Journal Information
Vol. 146. Issue 10.
Pages 468-469 (May 2016)
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Vol. 146. Issue 10.
Pages 468-469 (May 2016)
Letter to the Editor
Proctitis in an HIV-infected male who have sex with men
Proctitis en varón con relaciones sexuales con hombres e infectado por el virus de la inmunodeficiencia humana
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Joaquín Escobar-Sevillaa, Carmen Hidalgo-Tenoriob, José María Navarro-Maríc, José Gutiérrez-Fernándezc,d,
Corresponding author
a Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada, Granada, Spain
b Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada, Granada, Spain
c Servicio de Microbiología, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada, Granada, Spain
d Departamento de Microbiología, Universidad de Granada, Instituto de Investigación Biosanitaria de Granada, Granada, Spain
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