Sexually Transmitted Infections as a Cause of Proctitis in Men Who Have Sex with Men

PURPOSE:Many men who have sex with men (MSM) present with complaints of bleeding, pain, and inflammation. We endeavored to determine the incidence of sexually transmitted infections in MSM referred for treatment of these symptoms and the effect of empiric therapy. METHODS:A retrospective chart review of all MSM seen in 2007 at one surgical practice diagnosed with presumptive proctitis was performed. All MSM are routinely tested for sexually transmitted infections. RESULTS:Twenty-six MSM were identified (mean age, 38 years), and 17 (65 percent) were HIV+. Bleeding and pain were the most common complaints seen in 19 (73 percent) and 16 (62 percent), respectively. The most common findings were discharge in 15 (58 percent) and blood in 14 (54 percent). Sexually transmitted infections were identified in 21 (86 percent) and 3 (11 percent) had unidentified etiology. Gonorrhea was found in eight (43 percent), herpes simplex virus in six (29 percent), lymphogranuloma venereum in four (19 percent), and two each (10 percent) had Chlamydia and syphilis. Three had multiple infections. All but two treated empirically responded without complication and they had Crohn's colitis (n = 1) and rectal lymphoma (n = 1). CONCLUSIONS:Sexually transmitted infections are a common cause of proctitis and appropriate testing is imperative. Lymphogranuloma venereum is a common cause. Empiric treatment leads to rapid resolution and diminishes the chance for spread.