Proctitis infecciosa transmitida sexualmente: reto diagnóstico y recomendaciones de tratamiento

Abstract

La proctitis infecciosa (PI) transmitida sexualmente es un proceso inflamatorio del recto secundario a la infección por gérmenes de transmisión sexual. Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum y el virus herpes simple (VHS) son las causas más comunes. Es más prevalente en hombres que tienen sexo con hombres (HSH) y en pacientes con infección por el virus de inmunodeficiencia humana (VIH), sin embargo, también se diagnostica en heterosexuales por cambios en el comportamiento sexual. La urgencia fecal, el exudado purulento o sanguinolento, la proctalgia y el tenesmo son las manifestaciones clínicas más frecuentes. La historia clínica detallada y un alto índice de sospecha son importantes para establecer el diagnóstico de esta patología; apoyados en los estudios endoscópicos, histológicos, serológicos y microbiológicos. Se recomienda el tratamiento empírico, con a specha clínica y siempre deben descartarse otras infecciones de transmisión sexual (ITSs).

Immunohistochemical detection of chlamydia trachomatis in sexually transmitted infectious proctitis

“…These findings are in agreement with previous studies, only age is slightly lower compared to other publications, which reported an average of approximately 43 years [9,10]. These young patients typically present anal pain, tenesmus, constipation, and rectal bleeding [11]. In our study it was not possible to estimate the prevalence of these symptoms due to the lack of systematized information in the medical records, a problem that is quite common in our country.…”

Viruela símica en un paciente con VIH: reporte de caso

“…In this case, according to the clinical findings, the infectious agents ( Neisseria gonorrhoeae and MPXV) could have caused IP. However, the most common cause of IP is Neisseria gonorrhoeae, and its signs and symptoms were reported in this case; in addition, the response to treatment with ceftriaxone was good, which suggests that this microorganism may have been responsible; excluding Treponema Pallidum (primary syphilis), whose incubation period is usually from two to six weeks 16 .…”

“…Currently, there is no specific or approved treatment for mpox, so therapy mainly aims at managing symptoms. However, some antivirals called “of compassionate use” have been approved by the Food and Drug Administration (FDA) for treatment of human smallpox and have shown efficacy against mpox; the Centers for Disease Control and Prevention (CDC) guidelines suggest tecovirimat as first-line drug in patients with severe disease or who are at high risk of developing severe disease 16 .…”

“…En este caso, de acuerdo a los hallazgos clínicos, se podría inferir que los agentes infecciosos ( Neisseria gonorrhoeae y VVS ) son causantes de la PI. Sin embargo, la causa más común de PI es la Neisseria gonorrhoeae , cuya clínica es compatible con el presente caso; además, se observó buena respuesta a la administración de ceftriaxona, lo que sugiere como responsable a este agente infeccioso; excluyendo al Treponema Pallidum (sífilis primaria) debido a que el período de incubación es de dos a seis semanas 16 ).…”

Infectious proctitis: what every gastroenterologist needs to know

“…People with symptoms of acute proctitis with painful perianal or mucosal ulcers detected on proctological examination should receive presumptive treatment for genital herpes [ 7 ]. The diagnosis of anorectal HSV infection can be performed using PCR, which has a higher sensitivity compared to the gold standard test (culture virus in rectal tissue) [ 19 ]. Treatment options are acyclovir 400 mg t.i.d., valganciclovir 500 mg b.i.d., or famciclovir 250 mg t.i.d., for 5-10 days [ 8 , 20 ].…”