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Der Hautarzt

, Volume 66, Issue 6, pp 430–438 | Cite as

Sexuell übertragbare Erkrankungen der Analregion

  • P. Spornraft-RagallerEmail author
  • U. Boashie
  • S. Esser
Leitthema

Zusammenfassung

Hintergrund

Sexuell übertragbare Infektionen (STIs) sind in Zusammenhang mit der Behandelbarkeit der HIV-Infektion durch zunehmendes sexuelles Risikoverhalten bei Männern, die Sex mit Männern haben (MSM), gehäuft zu beobachten. Auch heterosexueller Analverkehr wird häufiger praktiziert als angenommen, sodass anorektale Manifestationen von STIs keine Seltenheit sind.

Ziel der Arbeit

Für häufige, sich im distalen Anorektalbereich manifestierende STIs werden klinische Manifestationen, diagnostische Möglichkeiten und die Therapie besprochen.

Ergebnisse und Diskussion

Aufgrund der Lokalisation und des oft asymptomatischen Verlaufs bestehen in dieser Region häufig diagnostische Schwierigkeiten. STIs können sich in dieser Region als tumoröse, ulzerative oder proktitische Prozesse äußern, die häufig als Malignome oder entzündliche Darmerkrankungen verkannt werden. Herpes simplex und Syphilis manifestieren sich vorwiegend als ulzerative Erkrankungen, die auch die Perianalregion betreffen, während Gonorrhö und Lymphogranuloma venereum eher exsudative proktitische Beschwerden hervorrufen. Aufgrund häufiger Koinfektionen sollte eine vollständige STI-Diagnostik durchgeführt werden.

Schlüsselwörter

Proktitis Syphilis Gonorrhö Lymphogranuloma venereum Herpes simplex 

Sexually transmitted infections of the anorectal region

Abstract

Background

Sexually transmitted infections (STIs) are increasingly observed in men who have sex with men (MSM), which is associated with the success in the antiretroviral treatment of HIV infection. Additionally, in heterosexuals, anal intercourse is more prevalent than previously assumed. Thus, anorectal manifestations of STIs are not a rare condition.

Objectives

This review will focus on the clinical picture, diagnosis and therapy of frequent STIs involving the anorectal region.

Conclusions

Due to localisation and frequent asymptomatic course, STIs in this region often pose diagnostic problems. Anorectal manifestations of STIs consist of tumorous masses, ulcers or proctitis and may be misdiagnosed as malignancy or inflammatory bowel disease. Herpes simplex and syphilis primarily show ulcerations and may involve the perianal region, whereas gonorrhoea and lymphogranuloma venereum mainly cause proctitic symptoms with exsudation. Because of commonly occurring coinfections a complete diagnostic workup concerning other STIs should be performed.

Keywords

Proctitis Syphilis Gonorrhea Lymphogranuloma venereum Herpes simplex 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

P. Spornraft-Ragaller, U. Boashie und S. Esser geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Abraham S, Pöhlmann C, Spornraft-Ragaller P (2013) Gonorrhoe: Daten über 10 Jahre zu Resistenzlage und Begleitinfektionen am Universitätsklinikum Dresden. J Dtsch Dermatol Ges 11(3):241–249PubMedGoogle Scholar
  2. 2.
    Adachi E, Koibuchi T, Okame M et al (2011) Case of secondary syphilis presenting with unusual complications: syphilitic proctitis, gastritis, and hepatitis. J Clin Microbiol 49(12):4394–4396PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Assi R, Hashim PW, Reddy VB et al (2014) Sexually transmitted infections of the anus and rectum. World J Gastroenterol 20(41):15262–15268PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
  5. 5.
  6. 6.
  7. 7.
    Bissessor M, Fairley CK, Read T et al (2013) The etiology of infectious proctitis in men who have sex with men differs according to HIV status. Sex Transm Dis 40(10):768–770PubMedCrossRefGoogle Scholar
  8. 8.
    van den Bos RR, van der Meijden WI (2007) Persistent high-risk sexual behaviour in men who have sex with men after symptomatic lymphogranuloma venereum proctitis. Int J STD AIDS 18(10):715–716PubMedCrossRefGoogle Scholar
  9. 9.
    Cone MM, Whitlow CB (2013) Sexually transmitted and anorectal infectious diseases. Gastroenterol Clin North Am 42(4):877–892PubMedCrossRefGoogle Scholar
  10. 10.
    Deheragoda P (1977) Diagnosis of rectal gonorrhoea by blind anorectal swabs compared with direct vision swabs taken via a proctoscope. Br J Vener Dis 53(5):311–313PubMedCentralPubMedGoogle Scholar
  11. 11.
    Drusin LM, Homan WP, Dineen P (1976) The role of surgery in primary syphilis of the anus. Ann Surg 184(1):65–67PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
  13. 13.
    Dudareva-Vizule S, Haar K, Sailer A, PARIS study group et al (2014) Prevalence of pharyngeal and rectal Chlamydia trachomatis and Neisseria gonorrhoeae infections among men who have sex with men in Germany. Sex Transm Infect 90(1):46–51PubMedCrossRefGoogle Scholar
  14. 14.
  15. 15.
  16. 16.
    Febbraro I, Manetti G, Balestrieri P, Zippi M (2008) Rectal cancer or rectal chancre? Beware of primary syphilis. Dig Liver Dis 40(7):579–581PubMedCrossRefGoogle Scholar
  17. 17.
    Felt-Bersma RJ, Bartelsman JF (2009) Haemorrhoids, rectal prolapse, anal fissure, peri-anal fistulae and sexually transmitted diseases. Best Pract Res Clin Gastroenterol 23:575–592PubMedCrossRefGoogle Scholar
  18. 18.
    Freeman EE, Weiss HA, Glynn JR et al (2006) Herpes simplex virus 2 infection increases HIV acquisition in men and women: systematic review and metaanalysis of longitudinal studies. AIDS 20:73–83PubMedCrossRefGoogle Scholar
  19. 19.
    Garceau R, Leblanc D, Thibault L et al (2012) Herpes simplex virus type 1 is the leading cause of genital herpes in New Brunswick. Can J Infect Dis Med Microbiol 23(1):15–18PubMedCentralPubMedGoogle Scholar
  20. 20.
    Golparian D, Ohlsson A, Janson H et al (2014) Four treatment failures of pharyngeal gonorrhoea with ceftriaxone (500 mg) or cefotaxime (500 mg), Sweden, 2013 and 2014. Euro Surveill 19(30):pii/20862Google Scholar
  21. 21.
    Gupta R, Warren T, Wald A (2007) Genital herpes. Lancet 370:2127–2137PubMedCrossRefGoogle Scholar
  22. 22.
    Haar K, Dudareva-Vizule S, Wisplinghoff H et al (2013) Lymphogranuloma venereum in men screened for pharyngeal and rectal infection, Germany. Emerg Infect Dis 19(3):488–492PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Hamill M, Benn P, Carder C et al (2007) The clinical manifestations of anorectal infection with lymphogranuloma venereum (LGV) versus non-LGV strains of Chlamydia trachomatis: a case-control study in homosexual men. Int J STD AIDS 18(7):472–475PubMedCrossRefGoogle Scholar
  24. 24.
    Hellenbrand W, Thierfelder W, Müller-Pebody B et al (2005) Seroprevalence of herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) in former East and West Germany, 1997–1998. Eur J Clin Microbiol Infect Dis 24(2):131–135PubMedCrossRefGoogle Scholar
  25. 25.
    Ison CA, Town K, Obi C, GRASP collaborative group et al (2013) Decreased susceptibility to cephalosporins among gonococci: data from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) in England and Wales, 2007–2011. Lancet Infect Dis 13(9):762–768Google Scholar
  26. 26.
  27. 27.
  28. 28.
    Jones DJ, Goorney BP (1992) ABC of colorectal diseases. Sexually transmitted diseases and anal papillomas. BMJ 305(6857):820–823PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Ehrhard I (2014) Landesuntersuchungsanstalt für das Gesundheits- und Veterinärwesen, Freistaat Sachsen, pers. MitteilungGoogle Scholar
  30. 30.
    Langenberg AG, Corey L, Ashley Rl et al (1999) A prospective study of new infections with herpes simplex virus type 1 and type 2. Chiron HSV Vaccine Study Group. N Engl J Med 341:1432–1438PubMedCrossRefGoogle Scholar
  31. 31.
    Lautenschlager S (2013) Anorektale Manifestationen sexuell übertragbarer Infektionen. Ther Umsch 70(7):407–416PubMedCrossRefGoogle Scholar
  32. 32.
    Mindel A, Tovey SJ, Timmins DJ, Williams P (1989) Primary and secondary syphilis, 20 years’ experience. 2. Clinical features. Genitourin Med 65(1):1–3PubMedCentralPubMedGoogle Scholar
  33. 33.
    Mitchell M, Rane V, Fairley CK et al (2013) Sampling technique is important for optimal isolation of pharyngeal gonorrhoea. Sex Transm Infect 89(7):557–560PubMedCrossRefGoogle Scholar
  34. 34.
    Robert Koch-Institut (2012) Epid Bull 47:472–476Google Scholar
  35. 35.
    Robert Koch-Institut (2014) Epid Bull 38:373–380Google Scholar
  36. 36.
    Rönn MM, Ward H (2011) The association between lymphogranuloma venereum and HIV among men who have sex with men: systematic review and meta-analysis. BMC Infect Dis 11:70. doi:10.1186/1471-2334-11-70PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Savage EJ, van de Laar MJ, Gallay A, European Surveillance of Sexually Transmitted Infections (ESSTI) network et al (2009) Lymphogranuloma venereum in Europe, 2003–2008. Euro Surveill 14(48):pii/19428Google Scholar
  38. 38.
    Schachter J, Moncada J, Liska S et al (2008) Nucleic acid amplification tests in the diagnosis of chlamydial and gonococcal infections of the oropharynx and rectum in men who have sex with men. Sex Transm Dis 35(7):637–642PubMedCrossRefGoogle Scholar
  39. 39.
    Soni S, Srirajaskanthan R, Lucas SB et al (2010) Lymphogranuloma venereum proctitis masquerading as inflammatory bowel disease in 12 homosexual men. Aliment Pharmacol Ther 32(1):59–65PubMedCrossRefGoogle Scholar
  40. 40.
    Voeller B (1991) AIDS and heterosexual anal intercourse. Arch Sex Behav 20(3):233–276PubMedCrossRefGoogle Scholar
  41. 41.
    de Vries HJ, Morré SA, White JA, Moi H (2010) European guideline for the management of lymphogranuloma venereum. Int J STD AIDS 21(8):533–536PubMedCrossRefGoogle Scholar
  42. 42.
    de Vries HJ, Smelov V, Ouburg S et al (2010) Anal lymphogranuloma venereum infection screening with IgA anti-Chlamydia trachomatis-specific major outer membrane protein serology. Sex Transm Dis 37:789–795PubMedCrossRefGoogle Scholar
  43. 43.
    de Vries HJ, Zingoni A, White JA et al (2013) 2013 European Guideline on the management of proctitis, proctocolitis and enteritis caused by sexually transmissible pathogens. Int J STD AIDS 25(7):465–474PubMedCrossRefGoogle Scholar
  44. 44.
    de Vrieze NH, van Rooijen M, van der Loeff MF et al (2013) Anorectal and inguinal lymphogranuloma venereum among men who have sex with men in Amsterdam, the Netherlands: trends over time, symptomatology and concurrent infections. Sex Transm Infect 89:548–552PubMedCrossRefGoogle Scholar
  45. 45.
    de Vrieze NH, van Rooijen M, Speksnijder AG, de Vries HJ (2013) Urethral lymphogranuloma venereum infections in men with anorectal lymphogranuloma venereum and their partners: the missing link in the current epidemic? Sex Transm Dis 40(8):607–608PubMedCrossRefGoogle Scholar
  46. 46.
  47. 47.
    Yilmaz M, Memisoglu R, Aydin S et al (2011) Anorectal syphilis mimicking Crohn’s disease. J Infect Chemother 17(5):713–715PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Klinik und Poliklinik für DermatologieUniversitätsklinikum Carl Gustav Carus, Technische Universität DresdenDresdenDeutschland
  2. 2.Klinik für DermatologieUniversitätsklinikum EssenEssenDeutschland

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