Sexually Transmitted and Infectious Diarrheal Diseases

  • Reza Arsalani-Zadeh
  • Christina Cellini
  • Lester Gottesman


Sexually transmitted infections (STIs) continue to be a tremendous health burden. In the United States it is estimated that 15 million persons acquire an STI each year. Diagnosis, treatment and prevention guidelines continue to evolve. Patients with STIs often present with nonspecific symptoms and findings. The anorectum has been used with increasing frequency for sexual fulfillment over the past several decades, resulting in an explosive growth in the incidence of STIs which affect the anorectum. This chapter will discuss the bacterial and viral pathogens associated with anorectal proctitis.


Proctitis Sexually transmitted infections Anorectum HIV MSM 


  1. 1.
    Workowski KA. Centers for disease control and prevention sexually transmitted diseases treatment guidelines. Clin Infect Dis. 2015;61(Suppl 8):S759–62.PubMedCrossRefGoogle Scholar
  2. 2.
    Turner CF, Danella RD, Rogers SM. Sexual behavior in the United States 1930-1990: trends and methodological problems. Sex Transm Dis. 1995;22(3):173–90.PubMedCrossRefGoogle Scholar
  3. 3.
    Peterson JL, Coates TJ, Catania JA, Middleton L, Hilliard B, Hearst N. High-risk sexual behavior and condom use among gay and bisexual African-American men. Am J Public Health. 1992;82(11):1490–4.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Moscicki AB, Millstein SG, Broering J, Irwin CE Jr. Risks of human immunodeficiency virus infection among adolescents attending three diverse clinics. J Pediatr. 1993;122(5 Pt 1):813–20.PubMedCrossRefGoogle Scholar
  5. 5.
    MacDonald NE, Wells GA, Fisher WA, Warren WK, King MA, Doherty JA, et al. High-risk STD/HIV behavior among college students. JAMA. 1990;263(23):3155–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Willcox RR. The rectum as viewed by the venereologist. Br J Vener Dis. 1981;57:1):1–6.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Markland AD, Dunivan GC, Vaughan CP, Rogers RG. Anal intercourse and fecal incontinence: evidence from the 2009-2010 National Health and Nutrition Examination Survey. Am J Gastroenterol. 2016;111(2):269–74.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Silverman BG, Gross TP. Use and effectiveness of condoms during anal intercourse. A review. Sex Transm Dis. 1997;24(1):11–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(Rr-03):1–137.PubMedPubMedCentralGoogle Scholar
  10. 10.
    DiCarlo RP, Martin DH. The clinical diagnosis of genital ulcer disease in men. Clin Infect Dis. 1997;25(2):292–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Satterwhite CL, Torrone E, Meites E, Dunne EF, Mahajan R, Ocfemia MC, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013;40(3):187–93.PubMedCrossRefGoogle Scholar
  12. 12.
    CDC. Sexually transmitted disease surveillance 2014–2015.Google Scholar
  13. 13.
    Klein EJ, Fisher LS, Chow AW, Guze LB. Anorectal gonococcal infection. Ann Intern Med. 1977;86(3):340–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Janda WM, Bohnoff M, Morello JA, Lerner SA. Prevalence and site-pathogen studies of Neisseria meningitidis and N gonorrhoeae in homosexual men. JAMA. 1980;244(18):2060–4.PubMedCrossRefGoogle Scholar
  15. 15.
    Modesto VL, Gottesman L. Sexually transmitted diseases and anal manifestations of AIDS. Surg Clin North Am. 1994;74(6):1433–64.PubMedCrossRefGoogle Scholar
  16. 16.
    Geisler WM. Diagnosis and management of uncomplicated chlamydia trachomatis infections in adolescents and adults: summary of evidence reviewed for the 2015 centers for disease control and prevention sexually transmitted diseases treatment guidelines. Clin Infect Dis. 2015;61(Suppl 8):S774–84.PubMedCrossRefGoogle Scholar
  17. 17.
    Bazan JA, Carr Reese P, Esber A, Lahey S, Ervin M, Davis JA, et al. High prevalence of rectal gonorrhea and Chlamydia infection in women attending a sexually transmitted disease clinic. J Womens Health. 2015;24(3):182–9.CrossRefGoogle Scholar
  18. 18.
    van Liere GA, Hoebe CJ, Dukers-Muijrers NH. Evaluation of the anatomical site distribution of chlamydia and gonorrhoea in men who have sex with men and in high-risk women by routine testing: cross-sectional study revealing missed opportunities for treatment strategies. Sex Transm Infect. 2014;90(1):58–60.PubMedCrossRefGoogle Scholar
  19. 19.
    van Liere GA, van Rooijen MS, Hoebe CJ, Heijman T, de Vries HJ, Dukers-Muijrers NH. Prevalence of and factors associated with rectal-only chlamydia and gonorrhoea in women and in men who have sex with men. PLoS One. 2015;10(10):e0140297.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Passos MRL. Lymphogranuloma venereum: LGV. In: Passos M, editor. Atlas of sexually transmitted diseases. Cham: Springer; 2018.CrossRefGoogle Scholar
  21. 21.
    Schachter J. Chlamydial infections (first of three parts). N Engl J Med. 1978;298(8):428–35.PubMedCrossRefGoogle Scholar
  22. 22.
    CDC Rftl-bdoCtaNg-, MMWR-Recommendations and Reports 63(2).Google Scholar
  23. 23.
    Geisler WM, Uniyal A, Lee JY, Lensing SY, Johnson S, Perry RC, Kadrnka CM, Kerndt PR. Azithromycin versus doxycycline for urogenital chlamydia trachomatis infection. N Engl J Med. 2015;373(26):2512–21.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Safavi A, Gottesman L, Dailey TH. Anorectal surgery in the HIV+ patient: update. Dis Colon Rectum. 1991;34(4):299–304.PubMedCrossRefGoogle Scholar
  25. 25.
    Blank LJ, Rompalo AM, Erbelding EJ, Zenilman JM, Ghanem KG. Treatment of syphilis in HIV-infected subjects: a systematic review of the literature. Sex Transm Infect. 2011;87(1):9–16.PubMedCrossRefGoogle Scholar
  26. 26.
    Jacobs E. Anal infections caused by herpes simplex virus. Dis Colon Rectum. 1976;19(2):151–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Corey L, Spear PG. Infections with herpes simplex viruses (2). N Engl J Med. 1986;314(12):749–57.PubMedCrossRefGoogle Scholar
  28. 28.
    Fleming DT, McQuillan GM, Johnson RE, Nahmias AJ, Aral SO, Lee FK, et al. Herpes simplex virus type 2 in the United States, 1976 to 1994. N Engl J Med. 1997;337(16):1105–11.PubMedCrossRefGoogle Scholar
  29. 29.
    Baringer JR. Recovery of herpes simplex virus from human sacral ganglions. N Engl J Med. 1974;291(16):828–30.PubMedCrossRefGoogle Scholar
  30. 30.
    Benedetti J, Corey L, Ashley R. Recurrence rates in genital herpes after symptomatic first-episode infection. Ann Intern Med. 1994;121(11):847–54.PubMedCrossRefGoogle Scholar
  31. 31.
    Assi R, Hashim PW, Reddy VB, Einarsdottir H, Longo WE. Sexually transmitted infections of the anus and rectum. World J Gastroenterol. 2014;20(41):15262–8.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Munro CL. The impact of recent advances in microbiology and immunology on perinatal and women’s health care. J Obstet Gynecol Neonatal Nurs. 1995;24(6):525–31.PubMedCrossRefGoogle Scholar
  33. 33.
    Ashley-Morrow R, Krantz E, Wald A. Time course of seroconversion by HerpeSelect ELISA after acquisition of genital herpes simplex virus type 1 (HSV-1) or HSV-2. Sex Transm Dis. 2003;30(4):310–4.PubMedCrossRefGoogle Scholar
  34. 34.
    Casper C, Krantz E, Taylor H, Dalessio J, Carrell D, Wald A, et al. Assessment of a combined testing strategy for detection of antibodies to human herpesvirus 8 (HHV-8) in persons with Kaposi’s sarcoma, persons with asymptomatic HHV-8 infection, and persons at low risk for HHV-8 infection. J Clin Microbiol. 2002;40(10):3822–5.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Whittington WL, Celum CL, Cent A, Ashley RL. Use of a glycoprotein G-based type-specific assay to detect antibodies to herpes simplex virus type 2 among persons attending sexually transmitted disease clinics. Sex Transm Dis. 2001;28(2):99–104.PubMedCrossRefGoogle Scholar
  36. 36.
    Stamm WE, Handsfield HH, Rompalo AM, Ashley RL, Roberts PL, Corey L. The association between genital ulcer disease and acquisition of HIV infection in homosexual men. JAMA. 1988;260(10):1429–33.PubMedCrossRefGoogle Scholar
  37. 37.
    Holmberg SD, Stewart JA, Gerber AR, Byers RH, Lee FK, O’Malley PM, et al. Prior herpes simplex virus type 2 infection as a risk factor for HIV infection. JAMA. 1988;259(7):1048–50.PubMedCrossRefGoogle Scholar
  38. 38.
    Ho GY, Bierman R, Beardsley L, Chang CJ, Burk RD. Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med. 1998;338(7):423–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Bosch FX, Manos MM, Munoz N, Sherman M, Jansen AM, Peto J, et al. Prevalence of human papillomavirus in cervical cancer: a worldwide perspective. International biological study on cervical cancer (IBSCC) Study Group. J Natl Cancer Inst. 1995;87(11):796–802.PubMedCrossRefGoogle Scholar
  40. 40.
    Clifford GM, Smith JS, Plummer M, Munoz N, Franceschi S. Human papillomavirus types in invasive cervical cancer worldwide: a meta-analysis. Br J Cancer. 2003;88(1):63–73.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Garland SM, Steben M, Sings HL, James M, Lu S, Railkar R, et al. Natural history of genital warts: analysis of the placebo arm of 2 randomized phase III trials of a quadrivalent human papillomavirus (types 6, 11, 16, and 18) vaccine. J Infect Dis. 2009;199(6):805–14.PubMedCrossRefGoogle Scholar
  42. 42.
    Gissmann L, Wolnik L, Ikenberg H, Koldovsky U, Schnurch HG, zur Hausen H. Human papillomavirus types 6 and 11 DNA sequences in genital and laryngeal papillomas and in some cervical cancers. Proc Natl Acad Sci U S A. 1983;80(2):560–3.CrossRefGoogle Scholar
  43. 43.
    Sonnex C, Strauss S, Gray JJ. Detection of human papillomavirus DNA on the fingers of patients with genital warts. Sex Transm Infect. 1999;75(5):317–9.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Hoyme UB, Hagedorn M, Schindler AE, Schneede P, Hopfenmuller W, Schorn K, et al. Effect of adjuvant imiquimod 5% cream on sustained clearance of anogenital warts following laser treatment. Infect Dis Obstet Gynecol. 2002;10(2):79–88.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Schofer H. Evaluation of imiquimod for the therapy of external genital and anal warts in comparison with destructive therapies. Br J Dermatol. 2007;157(Suppl 2):52–5.PubMedCrossRefGoogle Scholar
  46. 46.
    Nathan M, Singh N, Garrett N, Hickey N, Prevost T, Sheaff M. Performance of anal cytology in a clinical setting when measured against histology and high-resolution anoscopy findings. AIDS. 2010;24(3):373–9.PubMedCrossRefGoogle Scholar
  47. 47.
    Goldstone SE, Johnstone AA, Moshier EL. Long-term outcome of ablation of anal high-grade squamous intraepithelial lesions: recurrence and incidence of cancer. Dis Colon Rectum. 2014;57(3):316–23.PubMedCrossRefGoogle Scholar
  48. 48.
    Palefsky JM. Screening to prevent anal cancer: current thinking and future directions. Cancer Cythopathol. 2015;123(9):509–10.CrossRefGoogle Scholar
  49. 49.
    Deshmukh AA, Chhatwal J, Chiao EY, Nyitray AG, Das P, Cantor SB. Long-term outcomes of adding HPV vaccine to the anal intraepithelial neoplasia treatment regimen in HIV-positive men who have sex with men. Clin Infect Dis. 2015;61(10):1527–35.PubMedPubMedCentralCrossRefGoogle Scholar
  50. 50.
    Katzman M, Carey JT, Elmets CA, Jacobs GH, Lederman MM. Molluscum contagiosum and the acquired immunodeficiency syndrome: clinical and immunological details of two cases. Br J Dermatol. 1987;116(1):131–8.PubMedCrossRefGoogle Scholar
  51. 51.
    Miller SJ. Cutaneous cryptococcus resembling molluscum contagiosum in a patient with acquired immunodeficiency syndrome. Cutis. 1988;41(6):411–2.PubMedGoogle Scholar
  52. 52.
    Lifson AR, Rutherford GW, Jaffe HW. The natural history of human immnnodeficiencyvirus infection. J Infect Dis. 1988;158:1360–7.PubMedCrossRefGoogle Scholar
  53. 53.
  54. 54.
    Khosropour C, et al. Trends in serosorting and the association with HIV/STI risk over time among men who have sex with men. JAIDS. 2016;72(2):189–97.PubMedGoogle Scholar
  55. 55.
    Centeres for Disease Control and Prevention. Legal status of expedited partner therapy. Accessed 12 Sep 2016.
  56. 56.
    Workowski KA, Bolan GA. Sexually treamitted idsease treatment guidelines 2015. MMWR Recomm Rep. 2015;64(RR-03):1–137.PubMedPubMedCentralGoogle Scholar
  57. 57.
    Nidimusili AJ, Eisa N, Shaheen K. Gastrointestinal Kaposi’s sarcoma presenting as ileocolic intussusception. N Am J Med Sci. 2013;5(11):666–8.PubMedPubMedCentralCrossRefGoogle Scholar
  58. 58.
    Garg P. Nontuberculous mycobacteria in fistula-in-ano. A new findings and its implication. Int J Mycobaceteriol. 2016;5(3):276–9.CrossRefGoogle Scholar
  59. 59.
    Muller M, Wandel S, Colebunders R, et al. Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systemic review and meta-analysis. Lancet Infect Dis. 2010;10:251–61.PubMedPubMedCentralCrossRefGoogle Scholar
  60. 60.
    McKendry A, Naravana S, Browne R. Atypical presentations of genital herpes simplex virus in HIV-2 and HIV-2 effectively treated by imiquimod. Int J STDAIDS. 2015;26(4):441–3.Google Scholar
  61. 61.
    Vantrappen G, Ponette E, Geboes K, Bertrand P. Yersinia enteritis and enterocolitis: gastroenterological aspects. Gastroenterology. 1977;72(2):220–7.PubMedGoogle Scholar
  62. 62.
    Allason-Jones E, Mindel A. Sex and the bowel. Int J Color Dis. 1987;2(1):32–7.CrossRefGoogle Scholar
  63. 63.
    Dritz SK, Back AF. Letter: shigella enteritis venereally transmitted. N Engl J Med. 1974;291(22):1194.PubMedGoogle Scholar
  64. 64.
    Drusin LM, Genvert G, Topf-Olstein B, Levy-Zombek E. Shigellosis. Another sexually transmitted disease? Br J Vener Dis. 1976;52(5):348–50.PubMedPubMedCentralGoogle Scholar
  65. 65.
    William DC, Felman YM, Marr JS, Shookhoff HB. Sexually transmitted enteric pathogens in male homosexual population. N Y State J Med. 1977;77(13):2050–2.PubMedGoogle Scholar
  66. 66.
    Hawkins CC, Gold JW, Whimbey E, Kiehn TE, Brannon P, Cammarata R, et al. Mycobacterium avium complex infections in patients with the acquired immunodeficiency syndrome. Ann Intern Med. 1986;105(2):184–8.PubMedCrossRefGoogle Scholar
  67. 67.
    Wolke A, Meyers S, Adelsberg BR, Bottone EJ, Damsker B, Schwartz IS, et al. Mycobacterium avium-intracellulare-associated colitis in a patient with the acquired immunodeficiency syndrome. J Clin Gastroenterol. 1984;6(3):225–9.PubMedGoogle Scholar
  68. 68.
    Santangelo WC, Krejs GJ. Gastrointestinal manifestations of the acquired immunodeficiency syndrome. Am J Med Sci. 1986;292(5):328–34.PubMedCrossRefGoogle Scholar
  69. 69.
    Haddad FS, Ghossain A, Sawaya E, Nelson AR. Abdominal tuberculosis. Dis Colon Rectum. 1987;30(9):724–35.PubMedCrossRefGoogle Scholar
  70. 70.
    Rosengart TK, Coppa GF. Abdominal mycobacterial infections in immunocompromised patients. Am J Surg. 1990;159(1):125–31.PubMedCrossRefGoogle Scholar
  71. 71.
    Lange M, Klein EB, Kornfield H, Cooper LZ, Grieco MH. Cytomegalovirus isolation from healthy homosexual men. JAMA. 1984;252(14):1908–10.PubMedCrossRefGoogle Scholar
  72. 72.
    Foucar E, Mukai K, Foucar K, Sutherland DE, Van Buren CT. Colon ulceration in lethal cytomegalovirus infection. Am J Clin Pathol. 1981;76(6):788–801.PubMedCrossRefGoogle Scholar
  73. 73.
    Pomerantz MB, Marr JS, Goldman WD. Amebiasis in New York City 1958--1978: identification of the male homosexual high risk population. Bull N Y Acad Med. 1980;56(2):232–44.PubMedPubMedCentralGoogle Scholar
  74. 74.
    William DC, Shookhoff HB, Felman YM, DeRamos SW. High rates of enteric protozoal infections in selected homosexual men attending a venereal disease clinic. Sex Transm Dis. 1978;5(4):155–7.PubMedCrossRefGoogle Scholar
  75. 75.
    Phillips SC, Mildvan D, William DC, Gelb AM, White MC. Sexual transmission of enteric protozoa and helminths in a venereal-disease-clinic population. N Engl J Med. 1981;305(11):603–6.PubMedCrossRefGoogle Scholar
  76. 76.
    Brooks JL, Kozarek RM. Amebic colitis. Preventing morbidity and mortality from fulminant disease. Postgrad Med. 1985;78(1):267–74.PubMedCrossRefGoogle Scholar
  77. 77.
    Soave R, Danner RL, Honig CL, Ma P, Hart CC, Nash T, et al. Cryptosporidiosis in homosexual men. Ann Intern Med. 1984;100(4):504–11.PubMedCrossRefGoogle Scholar
  78. 78.
    Current WL, Reese NC, Ernst JV, Bailey WS, Heyman MB, Weinstein WM. Human cryptosporidiosis in immunocompetent and immunodeficient persons. Studies of an outbreak and experimental transmission. N Engl J Med. 1983;308(21):1252–7.PubMedCrossRefGoogle Scholar
  79. 79.
    Soave R. Cryptosporidiosis and isosporiasis in patients with AIDS. Infect Dis Clin N Am. 1988;2(2):485–93.Google Scholar
  80. 80.
    DeHovitz JA, Pape JW, Boncy M, Johnson WD Jr. Clinical manifestations and therapy of Isospora belli infection in patients with the acquired immunodeficiency syndrome. N Engl J Med. 1986;315(2):87–90.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Reza Arsalani-Zadeh
    • 1
  • Christina Cellini
    • 2
  • Lester Gottesman
    • 3
  1. 1.Department of Colorectal SurgeryUniversity of Rochester Medical CenterRochesterUSA
  2. 2.Department of SurgeryUniversity of Rochester Medical CenterRochesterUSA
  3. 3.Division of Colon and Rectal Surgery, Department of SurgeryMount SinaiNew YorkUSA

Personalised recommendations