The New England Journal of MedicineChlamydial Proctitis

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This case report describes a 26-year-old man diagnosed with chlamydial proctitis after presenting with fevers and bloody stools. The patient’s history of condomless receptive anal intercourse, along with CT and sigmoidoscopy findings, led to the diagnosis. The case highlights the importance of considering sexually transmitted infections in patients with rectal symptoms and appropriate sexual history, as well as the need for comprehensive STI testing, including HIV.

Key Points:

• A 26-year-old man presented with fevers and bloody stools 3 weeks after condomless receptive anal intercourse.
• CT showed rectal wall thickening and perirectal lymphadenopathy, while sigmoidoscopy revealed nodular mucosa with erythema and ulceration.
• Nucleic acid amplification testing of a rectal swab was positive for Chlamydia trachomatis, but negative for L serovars.
• The patient was also diagnosed with HIV, with a CD4 count of 551/mm³ and viral load of 129,000 copies/mL.
• Treatment with doxycycline and antiretroviral drugs led to resolution of rectal symptoms within 5 days.
• This case emphasizes the importance of considering STIs in patients with rectal symptoms and relevant sexual history.
• Comprehensive STI testing, including HIV, is crucial in such cases.

In 2020, a total of 1,579,885 cases of Chlamydia trachomatis infection were reported to the CDC, making it the most common notifiable sexually transmitted infection in the United States for that year. (CDC)

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