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

This guideline intents to offer guidance on the diagnosis and management of patients with gastrointestinal symptoms and a suspected sexually transmitted cause. Proctitis is defined as an inflammatory syndrome of the anal canal and/or the rectum. Infectious proctitis can be sexually transmitted via genital-anal mucosal contact, but some also via digital contact and toys. Neisseria gonorrhoeae, Chlamydia trachomatis (including lymphogranuloma venereum), Treponema pallidum and herpes simplex virus are the most common sexually transmitted anorectal pathogens. Shigellosis can be transferred via oral-anal contact and may lead to proctocolitis or enteritis. Although most studies on these infections have concentrated on men who have sex with men (MSM), women having anal intercourse may also be at risk. A presumptive clinical diagnosis of proctitis can be made when there are symptoms and signs, and a definitive diagnosis when the results of laboratory tests are available. The symptoms of proctitis include anorectal itching, pain, tenesmus, bleeding, constipation and discharge in and around the anal canal. The majority of rectal chlamydia and gonococcal infections are asymptomatic and can only be detected by laboratory tests. Therefore, especially when there is a history of receptive anal contact, exclusion of anorectal infections is generally indicated as part of standard screening for sexually transmitted infections (STIs). Condom use does not guarantee protection from STIs, which are often spread without penile penetration. New in this updated guideline is: (i) lymphogranuloma venereum proctitis is increasingly found in HIV-negative MSM, (ii) anorectal Mycoplasma genitalium infection should be considered in patients with symptomatic proctitis after exclusion of other common causations such N. gonorrhoeae, C. trachomatis, syphilis and herpes, (iii) intestinal spirochetosis incidentally found in colonic biopsies should not be confused with syphilis, and (iv) traumatic causes of proctitis should be considered in sexually active patients.

Las características epidemiológicas y clínicas de la epidemia de sífilis en Barcelona / The Epidemiological and Clinical Characteristics of the Epidemic of Syphilis in Barcelona

Introducción: Desde el año 2000 se ha descrito un aumento progresivo de los casos de sífilis en diferentes ciudades europeas, sobre todo en hombres que tienen sexo con hombres (HSH). Las manifestaciones clínicas de la sífilis pueden estar influidas por la coinfección del VIH o por el antecedente de sífilis. El objetivo del presente estudio es describir las características epidemiológicas y clínicas de los casos de sífilis precoz diagnosticados en Barcelona. Métodos: Estudio retrospectivo de casos de sífilis precoz diagnosticados en Barcelona (2003-2013). Se revisaron las historias clínicas y los datos epidemiológicos y clínicos fueron recogidos de forma estructurada. Las variables se compararon según el estatus serológico del VIH y el antecedente de sífilis. Resultados: Se diagnosticaron 1.702 casos de sífilis precoz (37% primaria, 48% secundaria y 14% latente precoz), 93% de ellos en HSH. Entre ellos, el 40% presentaba una coinfección por VIH. Los casos de sífilis en pacientes VIH positivos estaban asociados con un episodio previo de sífilis (aOR, 5,2 [IC del 95%, 3,32-8,24]) y con haber tenido sexo anal desprotegido (aOR, 1,75 [IC del 95%, 1,17-2,63]). Los casos con antecedentes de sífilis se presentaron con menor frecuencia como sífilis primaria (27,5% vs. 40%) (aOR, 0,58 [IC del 95%, 0,44-0,77]). Un año después del tratamiento, la evolución clínica y serológica fue similar en los pacientes VIH positivo y negativo. Conclusiones: La epidemia de sífilis en Barcelona afecta desproporcionalmente a HSH y está estrechamente relacionada con el VIH. La forma de presentación de la sífilis está influida por el antecedente de sífilis y por el VIH, sin diferencias significativas en cuanto a la evolución un año después del tratamiento

Background: Since 2000, substantial increases in syphilis have been reported in metropolitan areas of Western countries, with increases noted among men who have sex with men (MSM). Clinical manifestations of syphilis might be influenced by concomitant VIH infection and previous episodes of syphilis. The objectives of this study were to describe the epidemiological and clinical characteristics of the cases of syphilis diagnosed in Barcelona. Methods: Retrospective study of cases with early syphilis diagnosed in the referral STI Unit of Barcelona from January 2003 to December 2013. Revision of medical records with structured collection of epidemiological and clinical data. Univariate and multivariate statistical analyses comparing the characteristics of MSM cases with and without VIH infection and with and without previous syphilis. Results: A total of 1702 cases of syphilis (37% primary, 48% secondary and 14% early latent) were diagnosed, 93% of them in MSM. Among MSM 40% were coinfected with VIH, VIH-positive cases were associated with a previous syphilis (aOR, 5.2 [95% CI, 3.32-8.24]) and with unprotected anal intercourse (aOR, 1.75 [95%CI, 1.17-2.63]). Cases with a history of syphilis presented less often with primary syphilis compared to those without it (27.5% vs. 40%) (aOR, 0.58 [95% CI, 0.44-0.77]). One year after treatment, the clinical and serological evolution were similar between VIH-positive and VIH-negative cases. Conclusion: The epidemic of syphilis in Barcelona disproportionately affects MSM and is closelly linked to VIH infection. The presentation of syphilis is influenced by VIH infection and by previous history of syphilis, without significant differences in their evolution after one year of treatment

The Epidemiological and Clinical Characteristics of the Epidemic of Syphilis in Barcelona. / Las características epidemiológicas y clínicas de la epidemia de sífilis en Barcelona.

BACKGROUND: Since 2000, substantial increases in syphilis have been reported in metropolitan areas of Western countries, with increases noted among men who have sex with men (MSM). Clinical manifestations of syphilis might be influenced by concomitant VIH infection and previous episodes of syphilis. The objectives of this study were to describe the epidemiological and clinical characteristics of the cases of syphilis diagnosed in Barcelona. METHODS: Retrospective study of cases with early syphilis diagnosed in the referral STI Unit of Barcelona from January 2003 to December 2013. Revision of medical records with structured collection of epidemiological and clinical data. Univariate and multivariate statistical analyses comparing the characteristics of MSM cases with and without VIH infection and with and without previous syphilis. RESULTS: A total of 1702 cases of syphilis (37% primary, 48% secondary and 14% early latent) were diagnosed, 93% of them in MSM. Among MSM 40% were coinfected with VIH, VIH-positive cases were associated with a previous syphilis (aOR, 5.2 [95% CI, 3.32-8.24]) and with unprotected anal intercourse (aOR, 1.75 [95%CI, 1.17-2.63]). Cases with a history of syphilis presented less often with primary syphilis compared to those without it (27.5% vs. 40%) (aOR, 0.58 [95% CI, 0.44-0.77]). One year after treatment, the clinical and serological evolution were similar between VIH-positive and VIH-negative cases. CONCLUSION: The epidemic of syphilis in Barcelona disproportionately affects MSM and is closelly linked to VIH infection. The presentation of syphilis is influenced by VIH infection and by previous history of syphilis, without significant differences in their evolution after one year of treatment.

2019 European guideline on the management of lymphogranuloma venereum.

New or important issues in this updated version of the 2013 European guideline on the management of lymphogranuloma venereum (LGV): EPIDEMIOLOGY: Lymphogranuloma venereum continues to be endemic among European men who have sex with men (MSM) since 2003. Lymphogranuloma venereum infections in heterosexuals are extremely rare in Europe, and there is no evidence of transmission of LGV in the European heterosexual population. AETIOLOGY AND TRANSMISSION: Chlamydia trachomatis serovars/genovars L2b and L2 are the causative strains in the majority of cases in Europe. CLINICAL FEATURES: Among MSM, about 25% of the anorectal LGV infections are asymptomatic. Genital infections among MSM are rare; the ratio of genital vs. anorectal LGV infections is 1 in 15. DIAGNOSIS: To diagnose LGV, a sample tested C. trachomatis positive with a commercial nucleic acid amplification test (NAAT) platform should be confirmed with an LGV discriminatory NAAT. TREATMENT: Doxycycline 100 mg twice a day orally for 21 days is the recommended treatment for LGV. This same treatment is recommended also in asymptomatic patients and contacts of LGV patients. If another regimen is used, a test of cure (TOC) must be performed.

The Jarisch-Herxheimer reaction in syphilis: could molecular typing help to understand it better?

OBJECTIVES: The Jarisch-Herxheimer reaction (JHR) is a febrile inflammatory reaction that may occur in patients after treatment of syphilis. The overall rate is estimated to be 10-25% with broad variations over time. It appears to be related to factors like stage of the disease or reagin titres. In this study, we aimed to describe the incidence of and risk factors including strain typing for JHR among patients with syphilis. METHODS: From January through October 2015, 224 consecutive patients (82 of them with HIV) who were diagnosed with early syphilis were enrolled in this prospective observational study in a referral STI clinic in Barcelona. An appointment was offered to them after 10-14 days of treatment to inquire about the reaction with the use of a standardized form. Treponema pallidum molecular typing was made to detect a possible strain related to reaction. RESULTS: Overall, 28% of patients developed JHR. This varied from 56% in secondary, 37% in primary to 7% in early latent syphilis. The most frequent types of reaction were fever (57.5%) and worsening of the lesions (31%). The median time to development of JHR was 6 h [IQR 4-10 h] and lasted a median of 9 h [IQR 4-24 h]. The JHR was less probable in early latent compared to primary/secondary syphilis (P = 0.04) and in patients treated with doxycycline compared to those treated with penicillin (P = 0.01). No differences were seen regarding reagin titres or HIV status, and no association with a specific strain was found. CONCLUSIONS: In this study, JHR occurred in a similar frequency as in other contemporary studies. Symptomatic syphilis and treatment with penicillin were associated with an increased risk of JHR, whereas the previous episode of syphilis was associated with a low risk of it. We could not find associations with specific strains of T. pallidum.

FR - Sífilis: actualización en el manejo diagnóstico y terapéutico / Update on the Diagnosis and Treatment of Syphilis

No disponible

Lymphogranuloma venereum in Barcelona, 2007-2012: the role of seroadaptation in men who have sex with men.

This study describes the incidence rate of reported lymphogranuloma venereum (LGV) in men who have sex with men (MSM) in Barcelona from 2007 to 2012. Epidemiological, clinical and sexual behaviour characteristics of LGV cases are described. Seroadaptive behaviours as a transmission risk factor were assessed by a telephone questionnaire during 2012. Data were handled on a strictly confidential basis. LGV annual rate ratios in MSM were compared with cases from 2007. Differences were statistically analysed with a Poisson test. The incidence rate of LGV in MSM aged 15-69 years ranged from 32·1/105 MSM per year in 2007 to 182·7/105 MSM per year in 2012. In 2012, 31/51 LGV cases (61%) answered the telephone questionnaire, of which 84% (26/31) were HIV positive, 39% (12/31) reported having sex according to their partners' serostatus and 7% (2/31) used strategic positioning. The incidence of LGV has increased since 2007 and mainly affects HIV-positive MSM. It is probable that seroadaptation has facilitated LGV transmission.

European guideline for the management of chancroid, 2011.

Chancroid is a sexually acquired disease caused by Haemophilus ducreyi. The infection is characterized by one or more genital ulcers, which are soft and painful, and regional lymphadenitis which may develop into buboes. The infection may easily be misidentified due to its rare occurrence in Europe and difficulties in detecting the causative pathogen. H. ducreyi is difficult to culture. Polymerase chain reaction (PCR) can demonstrate the bacterium in suspected cases. Antibiotics will usually be efficient for curing chancroid.

[Lymphogranuloma venereum: an emerging cause of proctitis in homosexual men in Barcelona]. / Linfogranuloma venéreo: una causa emergente de proctitis en hombres homosexuales en Barcelona.

BACKGROUND AND OBJECTIVE: Lymphogranuloma venereum (LGV) is a systemic sexually transmitted infection (STI) caused by Chlamydia trachomatis serovar L. Since 2003, outbreaks of LGV have been reported in homosexual men in Europe. The objective of this study is to describe an outbreak of LGV in Barcelona in 2007. PATIENTS AND METHODS: Description of a clinical case series of confirmed LGV diagnosed in the STI clinic of Barcelona between September 2007 and January 2008. RESULTS: Seven cases have been confirmed up to January 31, 2008. All were homosexual men, with a mean age of 36, who were sexually promiscuous. Mean time of symptoms of proctitis was 28 days. All the patients were coinfected with human immunodeficiency virus (HIV) for an average period of 5 years. DISCUSSION: This outbreak is similar to other LGV outbreaks that are occurring in Europe. LGV should be considered in the differential diagnosis of proctitis in homosexual men and be treated with 100 mg of doxycycline/12 hours for three weeks. Preventive interventions directed at HIV infected persons are important.

Linfogranuloma venéreo: una causa emergente de proctitis en hombres homosexuales en Barcelona / Lymphogranuloma venereum: an emerging cause of proctitis in homosexual men in Barcelona

Fundamento y objetivo. El linfogranuloma venéreo (LGV) es una infección de transmisión sexual (ITS) sistémica causada por los serogrupos L de Chlamydia trachomatis. Desde 2003 se producen brotes de LGV en Europa afectando a hombres homosexuales. El objetivo del estudio es describir un brote de LGV en Barcelona en el año 2007.Pacientes y método. Descripción de la serie clínica de casos confirmados de LGV diagnosticados en la Unidad de ITS de Barcelona entre septiembre de 2007 y enero de 2008.Resultados. Hasta el 31 de enero de 2008 se confirmaron 7 casos. Todos eran hombres homosexuales, con una edad media de 36 años, promiscuos sexualmente. La duración media de los síntomas de proctitis fue de 28 días. Todos estaban coinfectados por el virus de la inmunodeficiencia humana (VIH) desde hacía un promedio de 5 años. Discusión. Este brote es parecido a los otros brotes de LGV que están ocurriendo en Europa. El LGV debe considerarse en el diagnóstico diferencial de proctitis en varones homosexuales y tratarse con 100 mg de doxiciclina cada 12 horas durante tres semanas. Es importante realizar intervenciones preventivas dirigidas a personas que están infectadas por el VIH (AU)

Background and objective. Lymphogranuloma venereum (LGV) is a systemic sexually transmitted infection (STI) caused by Chlamydia trachomatis serovar L. Since 2003, outbreaks of LGV have been reported in homosexual men in Europe. The objective of this study is to describe an outbreak of LGV in Barcelona in 2007. Patients and methods. Description of a clinical case series of confirmed LGV diagnosed in the STI clinic of Barcelona between September 2007 and January 2008.Results. Seven cases have been confirmed up to January 31, 2008. All were homosexual men, with a mean age of 36, who were sexually promiscuous. Mean time of symptoms of proctitis was 28 days. All the patients were coinfected with human immunodeficiency virus (HIV) for an average period of 5 years. Discussion. This outbreak is similar to other LGV outbreaks that are occurring in Europe. LGV should be considered in the differential diagnosis of proctitis in homosexual men and be treated with 100 mg of doxycycline/12 hours for three weeks. Preventive interventions directed at HIV infected persons are important (AU)

Sexually transmitted Chlamydia trachomatis, Neisseria gonorrhoeae, and HIV-1 infections in two at-risk populations in Barcelona: female street prostitutes and STI clinic attendees.

OBJECTIVE: To determine the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and HIV-1 infections in female street prostitutes and STI clinic attendees in Barcelona. DESIGN: This was a prospective study carried out in two four-month periods over two years. Urine specimens were tested for CT and NG using a PCR pooling algorithm. Among street prostitutes HIV-1 testing in urine was also carried out. RESULTS: The prevalences of CT, NG, and HIV-1 in female street prostitutes (n=301) were 4.7%, 3.7%, and 1.0%, respectively. Women from Eastern Europe had the highest prevalence of CT (p=0.01). Prevalences of CT, NG, and HIV-1 among all clinic attendees (n=536) were 4.3%, 4.5%, and 4.4%, respectively. Prevalence of HIV-1 infection among homosexual men was higher compared with heterosexual men and women (p<0.001). CONCLUSIONS: Overall CT prevalence is currently lower than in other European countries, although it could increase as a result of immigration. Rates of HIV-1 and of NG are higher among homosexual than among heterosexual men.

Réplica. Tuberculosis en zona de gran incidencia y con elevado porcentaje de inmigrantes / Reply. Tuberculosis in an area high incidence and a large percentage of immigrants

No disponible

[Tuberculous infection from an area of high incidence of tuberculosis and with a high proportion of immigrants]. / Estudio de la infección tuberculosa en una zona de gran incidencia de tuberculosis y con un elevado porcentaje de inmigrantes.

BACKGROUND: Historically the district of Ciutat Vella in Barcelona has a high incidence of tuberculosis (TB) and, more recently, it is home to a considerable proportion of immigrants. OBJECTIVES: To determine the prevalence of tuberculous infection (TI) in a pediatric population from this district and evaluate the impact of immigration. METHODS: Children and adolescents aged < 16 years old were screened using the tuberculin skin test (TST) mainly in visits of the healthy child program. Proportions were compared using the x2 test and adjusted odds ratios were estimated through a logistic regression model. RESULTS: Six hundred ninety-nine children were studied. The overall prevalence of positive TST was 3.4 % (95 % CI: 2.2 %-5.1 %). Prevalence increased with age (P 5 0.009) from 1.9 % in children aged 1-5 years old to 6.4 % in children and adolescents aged 10-15 years. A total of 88.3 % of the immigrants had been vaccinated with BCG compared with 2.5 % of autochthonous children and adolescents (P < 0.001). The prevalence ratio between immigrants and autochthonous children was 2.1 (P 5 0.07). Three cases of TB disease were detected among children, but no index case was found in children with TI. CONCLUSIONS: The high TI prevalence found suggest that living in the district is a risk factor, which justifies routine TST screening of all the children living there. The present criteria for the interpretation of TST in immigrants vaccinated with BCG residing in areas of high incidence are dubious.

Estudio de la infección tuberculosa en una zona de gran incidencia de tuberculosis y con un elevado porcentaje de inmigrantes / Tuberculous infection from an area of high incidence of tuberculosis and with a high proportion of immigrants

Antecedentes: Históricamente, el distrito Ciutat Vella de Barcelona presenta una elevada incidencia de tuberculosis y, más recientemente, alberga una proporción considerable de inmigrantes. Objetivos: Determinar la prevalencia de infección tuberculosa en una población pediátrica de dicho distrito, considerando el impacto de la inmigración. Métodos: Cribado de los niños menores de 16 años mediante la realización de la prueba de la tuberculina, mayoritariamente en las visitas del programa de atención al niño sano. Comparación de proporciones mediante la prueba estadística de la X2 y estimación odds ratio ajustadas mediante modelo de regresión logística. Resultados: Se estudiaron 699 niños. La prevalencia observada de pruebas de la tuberculina positivas fue 3,4 por ciento (intervalo de confianza [IC] 95 por ciento: 2,2-5,1), ésta aumentaba con la edad (p=0,009), desde 1,9 por ciento en niños de 1-5 hasta 6,4 por ciento en los de 10-15 años. Un 88,3 por ciento de los inmigrantes estaba vacunado con bacilo de Calmette-Guérin (BCG) frente al 2,5 por ciento de los autóctonos (p < 0,001). La razón de prevalencias entre los hijos de inmigrantes e inmigrantes y los niños autóctonos fue de 2,1 (p=0,07). Se detectaron 3 casos de tuberculosis en niños; no se encontró el foco en ningún caso entre los niños con infección tuberculosa. Conclusiones: La elevada prevalencia de infección tuberculosa observada sugiere que vivir en el distrito es un factor de riesgo, lo cual justifica realizar pruebas de tuberculina sistemáticas a los niños que residen allí. Los criterios actuales para valorar la prueba de la tuberculina en niños inmigrantes vacunados con BCG residentes en zonas de alta incidencia de tuberculosis, son dudosos (AU)

Previous STI and risk of HIV infection in men.

To determine the prevalence of a previous history of sexually transmitted infection (STI) and its influence as a risk factor for HIV infection among men tested for HIV, data from men having a voluntary HIV test at the STI Unit of Barcelona during a 6-month period of 1998 were analysed. Descriptive and logistic regression analysis were done to examine the prevalence of previous STI and factors associated with HIV infection. Prevalences of HIV were 5.6% in homo/bisexual and 0.5% in heterosexual men (P<0.001). Risk factors for HIV were STI history: odds ratio (OR)=8.7 and homo/bisexual behaviour: OR=6.6; 19.8% of heterosexuals had a history of STI compared with 44.2% of homo/bisexual men (P<0.01). A previous STI was associated with HIV seropositivity in homosexual men.

High rates of tuberculosis infection among children from Ciutat Vella District, Barcelona, 1996-1997.

With tuberculosis (TB) rates of over 160/100,000 in 1997, Ciutat Vella District, Barcelona, is the main community focus of TB in the city. For the purpose of TB screening, 415 children >2 years old from that district received a tuberculin skin test (TST); 27 (6.6%) (95%CI 4.5-9.3) were found to be infected but disease-free. The frequency of a positive TST increased significantly with age, from 0% in the 2-4 year age group to 14.6% in 10-14 year olds. Three culture-positive source adults, two of them sputum smear-positive, who were not previously known were traced from six TST-positive children. Previous BCG vaccination was not associated with a positive TST. These data support the use of universal TST screening in children living in Ciutat Vella District, Barcelona, as a means of identifying and treating TB cases.