Human intestinal spirochetosis, a sexually transmissible infection? Review of six cases from two sexually transmitted infection centres in Barcelona

Abstract

Human intestinal spirochetosis (HIS) is a possible cause of chronic diarrhoea and affects mainly men who have sex with men (MSM) and people living with HIV. Diagnosis is based on colon biopsy, where spirochetes can be observed on the luminal surface, especially with the Warthin-Starry stain or similar silver stains. We conducted a retrospective descriptive study of all HIS cases diagnosed in two sexually transmitted infections (STI) centres in Barcelona from 2009 until 2018. The medical histories were reviewed to gather epidemiological, clinical, and diagnostic variables. Six patients were diagnosed with HIS. All the individuals were MSM, with a median age of 31.5 years (interquartile range [IQR] 29.5;49.25) and half of them were living with HIV. Five patients reported condomless anal intercourse and 4 patients had practised oro-anal sex previously. Concomitantly, two of them had rectal gonorrhoea, one had rectal Chlamydia trachomatis and none of them had syphilis. The predominant clinical symptom was diarrhoea (5 patients). All cases were diagnosed by a Warthin-Starry stain on a colon biopsy specimen, and mild inflammatory changes were found in 5 cases. Five patients were treated with metronidazole and one with benzathine penicillin G. Treatment was successful in all the patients. HIS should be considered in patients with chronic diarrhoea who report risky sexual practices and/or concomitant STI. HIS may also be sexually transmitted according to the context.

Brushing Up on Brush Borders: Intestinal Spirochetosis Diagnosis and Management

“…13 One reason for this uncertainty is the high incidence of coinfection with other enteric bacteria. 14 In some case series, risks such as men who have sex with men, HIV virus infection, and co-infection with Neisseria gonorrhoeae or Chlamydia trachomatis were suggested. 15 In one series looking at 20 cases, 70% had CD4 lymphocyte cells >200/microL.…”

2021 European Guideline on the management of proctitis, proctocolitis and enteritis caused by sexually transmissible pathogens

“…Diagnosis is based on colon biopsy, where spirochetes can be observed on the luminal surface, especially with Warthin–Starry stain or similar silver stains. It is debated if colonization by these spirochetes is associated with gastrointestinal symptoms like chronic diarrhoea 41,42 …”

“…It is debated if colonization by these spirochetes is associated with gastrointestinal symptoms like chronic diarrhoea. 41,42 Anorectal herpes simplex virus infection Anorectal herpes simplex virus (HSV) infection is diagnosed by PCR (2,B). 43 Multiplex PCR may allow detection of unsuspected cases incidentally.…”

Human intestinal spirochetosis: A challenging condition

“…Human intestinal spirochetosis (HIS) is an uncommon entity often evolving unsuspected and may be incidentally detected in male patients who underwent colonoscopy with biopsy evaluations. [1][2][3][4][5][6] The major predisposing factors are male homosexuality and immunocompromised health conditions; the patients may be asymptomatic or have abdominal pain and chronic watery or bloody diarrhea. [1][2][3][4][5][6] The agents are from the Brachyspiraceae family (Brachyspira aalborgi and Brachyspira pilosicoli), and intestinal changes as polyps, diverticula, tubular adenoma, and aphthous ulcers are described.…”

“…[1][2][3][4][5][6] The major predisposing factors are male homosexuality and immunocompromised health conditions; the patients may be asymptomatic or have abdominal pain and chronic watery or bloody diarrhea. [1][2][3][4][5][6] The agents are from the Brachyspiraceae family (Brachyspira aalborgi and Brachyspira pilosicoli), and intestinal changes as polyps, diverticula, tubular adenoma, and aphthous ulcers are described. [1][2][3][4][5][6] Diagnosis confirmation depends on histopathology features including the classical presence of the agents in epithelial surface appearing as thread-like structures mimicking a palisade ("blue fringe").…”