Lower Gastrointestinal Syphilis: Case Series and Literature Review

Abstract

Background Syphilis infections are increasing globally. Lower gastrointestinal syphilis (LGIS) is a rare manifestation of early syphilis transmitted through anal sexual contact. Misdiagnosis of LGIS as inflammatory bowel disease may result from clinician under-awareness. Methods We searched the literature for articles describing cases of LGIS, and identified additional cases diagnosed within our institution. Data were extracted from the articles and medical records and analyzed to provide a summative account. Results 54 cases of LGIS were identified in 39 articles published between 1958 and 2020. 8 additional cases were diagnosed at our institution between 2011 and 2020, totaling 62 cases. All cases were described in men and transwomen aged 15 to 73 years. 50 (93%) individuals endorsed having sex with men. In 26 cases (52%) individuals were HIV co-infected. LGIS presented most commonly with hematochezia (67%) and anal pain (46%). The most common physical exam findings were rectal mass (38%), lymphadenopathy (31%), and rash (26%). Non-treponemal titers ranged from 1:2-1:1024. Of the 52 cases in which endoscopy was reported, 22 (42%) showed anorectal mass and 18 (35%) showed anorectal ulcer. In 44 cases (75%), histopathology revealed a chronic inflammatory infiltrate with a prominent lymphocyte component (45%) and/or plasma cells (36%). 78% of specimens to which a tissue stain was applied were positive for spirochetes. Conclusions LGIS should be suspected in men and transwomen presenting with a lower gastrointestinal symptom or mucosal abnormality. A sexual history must be elicited and guide testing. Misdiagnosis can delay treatment and threatens patient and public health.

Rectal Syphilis Mimicking Malignancy: A Case Report

“…그중 매독은 중증 급성 호흡기 증후군 코로나바이러스 2 (severe acute respiratory syndrome coronavirus 2; SARS-CoV-2)의 영향으로 감소한 2020년을 제외하고 한국에서 지속적 증가 추세를 보이고 있다( 1 2 ). 매독은 감염 시기에 따라 다양한 임상증상을 보이는데 직장 매독의 경우 무증상, 혈변, 복통, 잔변감, 설사 등의 증상을 동반하며 내시경 검사에서 종괴, 궤양, 점막부종 등의 비특이적인 모습으로 나타난다( 3 4 ). 보통의 경우 대장내시경 조직검사를 위해 입원한 환자에서 매독 검사를 필수적으로 시행하지는 않기 때문에 직장 매독을 직장암, 염증성 장 질환 등으로 오인하여 필요 없는 검사를 시행하거나 치료에 지연을 보이는 경우가 많다( 5 ).…”

“…보통의 경우 대장내시경 조직검사를 위해 입원한 환자에서 매독 검사를 필수적으로 시행하지는 않기 때문에 직장 매독을 직장암, 염증성 장 질환 등으로 오인하여 필요 없는 검사를 시행하거나 치료에 지연을 보이는 경우가 많다( 5 ). 또한 직장 매독의 경우 남성, 동성애자, HIV 동시 감염의 비율이 높기 때문에 환자의 역학적 특성, 성 경험, HI V감염과 같은 과거력을 자세히 조사하여 매독을 의심하는 것이 중요하다( 3 4 5 ).…”

Secondary anal fissures: a pain in the a**

“…3A) and indistinguishable from herpes (26,32). Lower GI syphilis is a rare manifestation of early syphilis (33). Endoscopic evaluation of syphilitic proctitis can show large, multiple irregular ulcers, sometimes opposite to one another or eccentrically located.…”

Was that endoscopy necessary?

“…Lower gastrointestinal syphilis should be suspected in patients with clinical manifestations of anal or rectal ulcers or pain, hematochezia, or mucopurulent secretions, especially if accompanied by lymphadenopathy or a skin rash. [ 1 ]…”