Abstract

Delayed diagnosis of colorectal sexually transmitted diseases due to their resemblance to inflammatory bowel diseases

Levy I1, Geffen Halevi S2, Nissan I3, Keller N4, Pilo S3, Wieder Finesod A5, Litchevski V5, Shasha D6, Kedem E7, Rahav G8. Int J Infect Dis. 2018 Aug 17. pii: S1201-9712(18)34491-6. doi: 10.1016/j.ijid.2018.08.004. [Epub ahead of print]
 
     

Author information

1 Infectious Disease Unit, Sheba medical center, Ramat Gan, Israel; Sackler medical school, Tel Aviv University, Israel; Immunology department and AIDS center, Rambam medical center, Haifa, Israel. Electronic address: itsik.levy@sheba.health.gov.il.

2 Microbiology Laboratory, Sheba medical center, Ramat Gan, Israel; Immunology department and AIDS center, Rambam medical center, Haifa, Israel.

3 Ministry of Health, National Public Health Laboratory, Chlamydia National Reference Laboratory, Tel Aviv; Immunology department and AIDS center, Rambam medical center, Haifa, Israel.

4 Microbiology Laboratory, Sheba medical center, Ramat Gan, Israel; Ariel University, Israel; Immunology department and AIDS center, Rambam medical center, Haifa, Israel.

5 Infectious Disease Unit, Sheba medical center, Ramat Gan, Israel; Immunology department and AIDS center, Rambam medical center, Haifa, Israel.

6 Infectious disease unit, Tel Aviv - Sourasky medical center, Tel Aviv; Immunology department and AIDS center, Rambam medical center, Haifa, Israel.

7 Infectious Disease Unit, Sheba medical center, Ramat Gan, Israel; Sackler medical school, Tel Aviv University, Israel; Microbiology Laboratory, Sheba medical center, Ramat Gan, Israel; Ministry of Health, National Public Health Laboratory, Chlamydia National Reference Laboratory, Tel Aviv; Ariel University, Israel; Infectious disease unit, Tel Aviv - Sourasky medical center, Tel Aviv; 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, Israel; Immunology department and AIDS center, Rambam medical center, Haifa, Israel.

Abstract

OBJECTIVE: Sexually transmitted diseases (STDs), mainly LGV (lymphogranuloma venereum) induces colorectal symptoms that may be misdiagnosed as inflammatory bowel diseases (IBD). To understand missed diagnosis of colorectal STDs and their association with LGV in Israel we describe patients that presented with STDs masquerading as IBD.

METHODS: In this retrospective descriptive study, we characterized clinical, endoscopic and pathologic findings of 16 patients that we diagnosed with colorectal STD after erroneously being diagnosed with IBD. Molecular genotyping was used to characterize some of the Chlamydia trachomatis isolates.

RESULTS: All patients were MSM, mostly HIV-1 positive and had clinical and endoscopic findings compatible with IBD. One to thirty-six months after the initial diagnosis, STD was diagnosed: Chlamydia trachomatis was positive in fourteen, of which three were of the LGV2b (ST58) serotype, Gonorrhea in five, and syphilis in four. In six episodes, several pathogens were diagnosed.

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 chlamydia trachomatis is diagnosed but LGV subtyping cannot be done, doxycycline 100mg BID for 21days should be recommended.

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