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Literature Review>02-2004>
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Etiology of Clinical Proctitis among Men Who Have Sex with Men

Author: John G. Bartlett, M.D.

Studies/Clinical Trials

  1. Klausner JD, Kohn R, Kent C; Etiology of clinical proctitis among men who have sex with men.; Clin Infect Dis 2004;38:300


This is a retrospective review of clinical proctitis in gay men seen at a STD clinic in San Francisco. The review included men with rectal symptoms of pain, itching, tenesmus, rectal bleeding or discharge who underwent clinical evaluation including anoscopy with diagnostic tests for C. trachomatis, N. gonorrhoeae, HSV and syphilis. The results show relatively high rates of gonorrhea, chlamydia, and HSV. No pathogen was found in 46 of the 101 patients studied. These results are summarized in the following table:

Pathogen Laboratory Findings
N. gonorrhoeae 30%
C. trachomatis 19%
Herpes simplex 16%
Syphilis 2%
No pathogen detected 46%


There were multiple studies of the newly recognized "gay bowel syndrome" in the late 1970s and early 1980s. However, subsequent attention and study has been sparse, in part attributed to reduced frequency thought to reflect changing practices by gay men in response to the HIV epidemic. This study clearly indicates that it is still an issue since the cases were studied in 2001-02. Also, the etiology is about the same as previously, although HSV is newly recognized as an important component. This finding not only effects management, but also has HIV prevention implications. The authors note that 2/3 of the participants were HIV negative and that proctitis increases the risk of HIV by up to nine fold (Craib, K Genitourinary Medicine 1995;71:150; Schwarcz, S J Infect Dis 2002;186:1019).
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