Sexually Transmitted Infectious Colitis vs Inflammatory Bowel Disease: Distinguishing Features From a Case-Controlled Study

Abstract

While STI colitis shares many overlapping features with IBD, histologic and clinical discriminating features may be helpful when confronted with that differential diagnosis.

Delayed diagnosis of colorectal sexually transmitted diseases due to their resemblance to inflammatory bowel diseases

“…The etiology may either be infectious, usually sexually transmitted, including Chlamydia trachomatis (mainly lymphogranuloma venereum (LGV)), gonorrhea, syphilis, and herpes simplex virus (HSV), or non-infectious, i.e., inflammatory bowel disease (IBD). Symptoms, signs, and endoscopic findings may be similar in both groups (Arnold et al, 2013(Arnold et al, , 2015Gallegos et al, 2012;Soni et al, 2010), leading to delayed diagnosis, the administration of inappropriate treatment, and transmission of the pathogen to sexual partners. In the last 15 years, the incidence of both LGV (Blank et al, 2005;Nieuwenhuis et al, 2004) and syphilis (Health Protection, 2009;Brosh-Nissimov et al, 2012) among MSM has increased, leading to increasing numbers of cases of STD-associated proctitis/proctocolitis misdiagnosed as IBD.…”

Syphilis in Maria Salviati (1499–1543), Wife of Giovanni de’ Medici of the Black Bands

“…Nevertheless, rectal syphilis is a rare disease that usually shows proctitis with perianal ulcers but lacks pathognomonic clinical symptoms, making diagnosis difficult. In clinical medicine, anal syphilis could be easily misdiagnosed as cancer or advanced stage hemorrhoids, upholding the reputation of syphilis as the "great mimicker" (41).…”

MALT lymphoma of the colon: a clinicopathological review

“…When present in the mucosa, the differential also includes IBD. Mucosal active chronic crypt-centric damage and mucosal eosinophils are more limited in syphilitic colitis 36. Treponema immunostains, as well as clinical history of HIV infection and anal pain, can be very helpful in distinguishing between MALT lymphoma and syphilitic colitis 36…”