Itzchak Levy1, Shiraz Gefen-Halevi2, Israel Nissan3, Natan Keller4, Shlomo Pilo3, Anat Wieder-Finesod5, Vlady Litchevski5, David Shasha6, Eynat Kedem7, Galia Rahav8. 1. Infectious Disease Unit, Sheba Medical Center, Ramat Gan, Israel; Sackler Medical School, Tel Aviv University, Tel Aviv, Israel. Electronic address: itsik.levy@sheba.health.gov.il. 2. Microbiology Laboratory, Sheba Medical Center, Ramat Gan, Israel. 3. Ministry of Health, National Public Health Laboratory, Chlamydia National Reference Laboratory, Tel Aviv, Israel. 4. Microbiology Laboratory, Sheba Medical Center, Ramat Gan, Israel; Ariel University, Ariel, Israel. 5. Infectious Disease Unit, Sheba Medical Center, Ramat Gan, Israel. 6. Infectious Disease Unit, Tel Aviv - Sourasky Medical Center, Tel Aviv, Israel. 7. Immunology Department and AIDS Center, Rambam Medical Center, Haifa, Israel. 8. Infectious Disease Unit, Sheba Medical Center, Ramat Gan, Israel; Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
Abstract
OBJECTIVE: Sexually transmitted diseases (STDs), mainly lymphogranuloma venereum (LGV), induce colorectal symptoms that may be misdiagnosed as inflammatory bowel disease (IBD). This study describes patients who presented with STDs masquerading as IBD in order to improve understanding of missed diagnosis of colorectal STDs and their association with LGV in Israel. METHODS: This retrospective, descriptive study characterized the clinical, endoscopic, and pathological findings of 16 patients who were diagnosed with a colorectal STD after erroneously being diagnosed with IBD. Molecular genotyping was used to characterize some of the Chlamydia trachomatis isolates. RESULTS: All patients were men who have sex with men (MSM), mostly HIV-1-positive, and had clinical and endoscopic findings compatible with IBD. The STD was diagnosed 1-36 months after the initial diagnosis: 14 were positive for Chlamydia trachomatis, of which three were of the LGV2b (ST58) serotype and one was ST 108 serotype. Five were positive for gonorrhea and four were positive for syphilis. Several pathogens were diagnosed in six episodes. CONCLUSIONS: Colorectal STDs may resemble IBD and therefore their diagnosis may be delayed. IBD symptoms in MSM who engage in non-protected anal sex should prompt at least syphilis and anal PCR for STD testing. If C. trachomatis is diagnosed but LGV subtyping cannot be done, doxycycline 100mg twice daily for 21days should be recommended.
OBJECTIVE: Sexually transmitted diseases (STDs), mainly lymphogranuloma venereum (LGV), induce colorectal symptoms that may be misdiagnosed as inflammatory bowel disease (IBD). This study describes patients who presented with STDs masquerading as IBD in order to improve understanding of missed diagnosis of colorectal STDs and their association with LGV in Israel. METHODS: This retrospective, descriptive study characterized the clinical, endoscopic, and pathological findings of 16 patients who were diagnosed with a colorectal STD after erroneously being diagnosed with IBD. Molecular genotyping was used to characterize some of the Chlamydia trachomatis isolates. RESULTS: All patients were men who have sex with men (MSM), mostly HIV-1-positive, and had clinical and endoscopic findings compatible with IBD. The STD was diagnosed 1-36 months after the initial diagnosis: 14 were positive for Chlamydia trachomatis, of which three were of the LGV2b (ST58) serotype and one was ST 108 serotype. Five were positive for gonorrhea and four were positive for syphilis. Several pathogens were diagnosed in six episodes. CONCLUSIONS:Colorectal STDs may resemble IBD and therefore their diagnosis may be delayed. IBD symptoms in MSM who engage in non-protected anal sex should prompt at least syphilis and anal PCR for STD testing. If C. trachomatis is diagnosed but LGV subtyping cannot be done, doxycycline 100mg twice daily for 21days should be recommended.
Authors: Elizabeth Ferzacca; Andrea Barbieri; Lydia Barakat; Maria C Olave; Dana Dunne Journal: Open Forum Infect Dis Date: 2021-03-29 Impact factor: 3.835
Authors: Raquel Pimentel; Catarina Correia; João Estorninho; Elisa Gravito-Soares; Marta Gravito-Soares; Pedro Figueiredo Journal: GE Port J Gastroenterol Date: 2021-05-06