Homosexuality and proctitis

According to the Mayo Clinic, proctitis is an "inflammation of the lining of the rectum... Sexually transmitted diseases are the most common cause, but other causes include inflammatory bowel diseases, such as ulcerative colitis, and non-sexually transmitted infections."[1]

According to the Mayo Clinic, proctitis is an "inflammation of the lining of the rectum... Sexually transmitted diseases are the most common cause, but other causes include inflammatory bowel diseases, such as ulcerative colitis, and non-sexually transmitted infections."[2] Sexually transmitted diseases that cause proctitis include gonorrhea, syphilis, cytomegalovirus, herpes, chlamydia, lymphogranuloma venereum, and amebiasis.[3][4] According to the Mayo Clinic, "proctitis in general mainly affects adult males".[5]

In 2009, the abstract for the medical journal article Sexually transmitted infections as a cause of proctitis in men who have sex with men which was published in the medical journal Diseases of the Colon & Rectum declared: "Many men who have sex with men (MSM) present with complaints of bleeding, pain, and inflammation... Sexually transmitted infections are a common cause of proctitis and appropriate testing is imperative. Lymphogranuloma venereum is a common cause."[6]

In 2006, the abstract for the medical journal article Sexually transmitted proctitis published in the medical journal Postgraduate Medical Journal declared:

“  |  Sexually transmitted infections such as chlamydia, gonorrhoea, herpes simplex virus and syphilis commonly present with rectal symptoms. Recent outbreaks of lymphogranuloma venereum among homosexual men throughout Europe highlight the need to consider sexually transmitted infections in the differential diagnosis of proctitis.[7] |  ”

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The Centers for Disease Control and Prevention (CDC) declared in 2015:

“  |  Sexually transmitted gastrointestinal syndromes include proctitis, proctocolitis, and enteritis. Evaluation for these syndromes should include appropriate diagnostic procedures (e.g., anoscopy or sigmoidoscopy, stool examination, and culture)...

Proctitis is inflammation of the rectum (i.e., the distal 10–12 cm) that can be associated with anorectal pain, tenesmus, or rectal discharge. N. gonorrhoeae, C. trachomatis (including LGV serovars), T. pallidum, and HSV are the most common sexually transmitted pathogens involved. In persons with HIV infection, herpes proctitis can be especially severe. Proctitis occurs predominantly among persons who participate in receptive anal intercourse.

Enteritis usually results in diarrhea and abdominal cramping without signs of proctitis or proctocolitis; it occurs among persons whose sexual practices include oral-anal contact. In otherwise healthy persons, Giardia lamblia is most frequently implicated. When outbreaks of gastrointestinal illness occur among social or sexual networks of MSM, clinicians should consider sexual transmission as a mode of spread and provide counseling accordingly. Among persons with HIV infection, enteritis can be caused by pathogens that may not be sexually transmitted, including CMV, Mycobacterium avium–intracellulare, Salmonella sp., Campylobacter sp., Shigella sp., Cryptosporidium, Microsporidium, and Isospora.[8]

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## Contents

* 1 Gay bowel syndrome and proctitis
* 1.1 Proctitis and HIV Infection Further Elaborated
* 1.2 Syphilis, Proctitis, and HIV Infection
* 1.3 Gonorrhea and Proctitis
* 1.4 Lymphogranuloma Venereum Outbreaks Among Homosexuals and HIV Infection
* 1.5 Amebiasis, Proctitis, and HIV Infection
* 2 See also
* 3 References

## Gay bowel syndrome and proctitis[edit]

See also: Gay bowel syndrome

Stylized rendering of a cross-section of the Human Immunodeficiency Virus

A September 2010 report of the Centers for Disease Control and Prevention (CDC) declared : "Gay, bisexual, and other men who have sex with men (MSM) represent approximately 2% of the US population, yet are the population most severely affected by HIV and are the only risk group in which new HIV infections have been increasing steadily since the early 1990s. In 2006, MSM accounted for more than half (53%) of all new HIV infections in the United States..."[9] In August of 2009, LifeSiteNews reported: "An official with the Centers for Disease Control and Prevention (CDC) announced the CDC's estimate Monday that in the United States AIDS is fifty times more prevalent among men who have sex with men ('MSM') than the rest of the population."[10]

On March 15, 2004 Medscape published an article entitled New Look at "Gay Bowel Syndrome" by John G. Bartlett, M.D. which commented on the 2004 journal article Etiology of clinical proctitis among men who have sex with men published by JD Klausner and C. Kent in the journal Clinical Infectious Diseases.

The Medscape article on gay bowel syndrome declared:

“  |  There were multiple studies of the newly recognized "gay bowel syndrome" in the late 1970s and early 1980s. However, subsequent attention and study has been sparse, in part attributed to reduced frequency thought to reflect changing practices by gay men in response to the HIV epidemic. This study clearly indicates that it is still an issue, since the cases were studied in 2001-2002. Also, the etiology is about the same as previously, although HSV is newly recognized as an important component. This finding not only affects management but also has HIV prevention implications. The authors note that two thirds of the participants were HIV negative and that proctitis increases the risk of HIV by up to 9-fold.[11] |  ”

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In 2014, the medical journal Current Opinion in Infectious Disease published a journal article entitled 'Gay bowel syndrome': relic or real (and returning) phenomenon? whose abstract indicated:

“  |  Purpose of Review: This article aims to review the term 'gay bowel syndrome', including the recent research looking at increased rates of bowel infections in men who have sex with men (MSM), particularly in light of the recent Shigella outbreaks in MSM in London and New York, and considers whether 'gay bowel syndrome' is a syndrome that really exists and is worthy of further research and specific treatment, or whether the term continues to be obsolete and not useful.

Recent findings: ...there seems to be a clustering of diseases in certain high-risk groups, especially those in urban areas with multiple sexual partners, recreational drug use, and possible concomitant HIV infection.

Summary: All healthcare practitioners (including non-sexual health/HIV specialists) need to consider careful and thorough history taking (including sexual history) to identify those at risk.[12][13]

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### Proctitis and HIV Infection Further Elaborated[edit]

As noted earlier proctitis is one of the maladies associated with gay bowel syndrome and greatly increases the chance of HIV infection.[14][15][16] In 2004, Jeffrey D. Klausner, Robert Kohn, and Charlotte Kent reported in the journal Clinical Infectious Diseases the following: "Proctitis, or inflammation of the rectum, is a condition that is not uncommon among men who have sex with men (MSM), and, in HIV-negative men, greatly increases the risk of acquiring HIV infection. With the recent increases in bacterial sexually transmitted diseases (STDs) among MSM in the United States and Europe, there has been a concomitant increase in the number of cases of clinical proctitis."[17]

Although homosexual men practice various sexual practices which may put them at risk, studies report that anal sex can be an important risk factor for the relay of many diseases.[18][19] Also, according to the Mayo Clinic, "proctitis is an inflammation of the lining of the rectum... Sexually transmitted diseases are the most common cause, but other causes include inflammatory bowel diseases, such as ulcerative colitis, and non-sexually transmitted infections."[20] Sexually transmitted diseases that cause proctitis include gonorrhea, syphilis, cytomegalovirus, herpes, chlamydia, lymphogranuloma venereum, shigella and amebiasis.[21][22] According to the Mayo Clinic article, proctitis is a condition mainly affecting adult males.

### Syphilis, Proctitis, and HIV Infection[edit]

See also: Homosexuality and syphilis

A Centers for Disease Control and Prevention analysis suggested that approximately 64 percent of all adult primary and secondary syphilis cases in 2004 were among men who have sex with men.

Syphilis and proctitis are both maladies associated with gay bowel syndrome as noted earlier.[23] Syphilis can be a cause of proctitis and the disease significantly increases the probability of HIV infection which was mentioned previously.[24][25]

The Center for Disease Control and Prevention reported:

“  |  Between 2016 and 2017, the number of reported primary and secondary (P&S) cases in the United States increased by 10.5%, and there were 30,644 P&S syphilis cases reported in 2017. Most (58%) of these cases were among MSM.[26] |  ”

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The news organization Cybercast News Service reported the following about homosexuality and syphilis:

“  |  The federal Centers for Disease Control and Prevention (CDC) says homosexual men accounted for 65 percent of the nearly 12,000 cases of syphilis in the United States in 2007, making them the “primary driver” of increased syphilis rates overall.

In a report on sexually transmitted diseases (STDs) issued Tuesday, the government said syphilis, a disease that was almost eliminated as a public health threat less than 10 years ago, is on the rise -- with cases increasing each year since 2000.[27]

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The CDC declared:

“  |  "While surveillance data are not available by risk behavior, a separate CDC analysis suggests that approximately 64 percent of all adult P&S syphilis cases in 2004 were among men who have sex with men, up from an estimated 5 percent in 1999....Syphilis increases, especially among men who have sex with men, demonstrate the need to continually adapt our strategies to eliminate syphilis in the United States,” said Dr. Ronald O. Valdiserri, acting director of CDC’s HIV, STD and TB prevention programs."[28] |  ”

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### Gonorrhea and Proctitis[edit]

See also: Homosexuality and gonorrhea

Gonorrhea is a sexually transmitted disease (STD) caused by the bacterium Neisseria gonorrhoeae.

Gonorrhea and proctitis are both maladies associated with gay bowel syndrome as noted earlier.[29] Gonorrhea can be a cause of proctitis and the disease significantly increases the probability of HIV infection as was mentioned previously.[30][31]

In 2017, the abstract for the medical journal article Frequent Transmission of Gonorrhea in Men Who Have Sex with Men published in the medical journal Emerging Infectious Diseases indicated:

“  |  The rate of gonorrhea is much higher in men who have sex with men than in heterosexuals. Because of unique behavioral characteristics, asymptomatic sites of infection, mainly the pharynx, are principal drivers of gonorrhea prevalence in men who have sex with men. On the basis of this observation, we call for interventions.

The rates of sexually transmitted infections are rising rapidly in men who have sex with men (MSM). Gonorrhea is of particular concern because rising rates will increase the probability of antimicrobial drug resistance. In response, the Centers for Disease Control and Prevention has recommended reducing the prevalence of gonorrhea as a key strategy to mitigate against antimicriobial resistance. However, reducing prevalence requires understanding why gonorrhea is so common in MSM. We suggest that specific sexual practices of MSM result in them having a high prevalence of asymptomatic infection in particular anatomic sites and that these infections are the primary drivers of transmission.[32]

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In 2006, the American Association of Family Physicians reported: "Men who have sex with men (MSM) have high rates of gonococcal infection. In San Francisco, more than one half of these infections occur in MSM, and previous cross-sectional studies have reported a prevalence of up to 15.3 percent in this group."[33]

In respect to homosexuality and gonorrhea, Concerned Women of America issued an article entitled Health and Homosexuality which stated the following: In a study published by the Canadian Medical Association Journal in 1991, '...gonorrhea was associated with urethral discharge ... and homosexuality (3.7 times higher than the rate among heterosexuals).'"[34]

### Lymphogranuloma Venereum Outbreaks Among Homosexuals and HIV Infection[edit]

See also: Homosexuality and lymphogranuloma venereum

There are three different sub-types of the bacteria Chlamydia trachomatis that cause lymphogranuloma venereum.

Lymphogranuloma venereum (LGV) is a sexually transmitted disease that can cause proctitis and proctitis significantly increases the probability of HIV infection. [35][36] Lymphogranuloma venereum and proctitis are both maladies associated with gay bowel syndrome.[37]

The abstract of the 2014 medical journal article Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case-control study in the U.K. which was published in the medical journal Sexually Transmitted Infections declares: "Since 2003, over 2000 cases of lymphogranuloma venereum (LGV) have been diagnosed in the U.K. in men who have sex with men (MSM). Most cases present with proctitis, but there are limited data on how to differentiate clinically between LGV and other pathology."[38]

In March of 2007, the Journal of Clinical Microbiology reported that there was an ongoing epidemic of lymphogranuloma venereum in men who have sex with men (MSM) in Europe, the United Kingdom, and North America. [39] In August of 2007, the Norweigan medical journal Tidsskrift for den Norske laegeforening stated that LGV has been a rare condition in the western world but since 2004 there have been frequent reports from larger cities in Europe and the United States and the outbreaks have been limited homosexual men.[40] The abstract for the January of 2007 journal Clinical Infectious Diseases states that "We found a significant burden of this once-rare sexually transmitted infection among MSM in the United Kingdom. LGV may be contributing to the epidemic of human immunodeficiency virus infection by facilitating transmission." [41] The reports of levels of proctitis in the homosexual men infected with lymphogranuloma venereum varied in the different outbreaks of lymphogranuloma venereum.[42][43][44]

### Amebiasis, Proctitis, and HIV Infection[edit]

See also: Homosexuality and parasites

As mentioned earlier, amebiasis and proctitis are both illnesses associated with gay bowel syndrome.[45] In addition, it was also indicated previously that amebiasis can cause proctitis which increases the risk factor in regards to HIV infection.[46][47]

The abstract for the 2017 Eurosurveillance journal article Outbreak of intestinal amoebiasis among men who have sex with men, Barcelona (Spain), October 2016 and January 2017 indicates: "Entamoeba histolytica has been recently recognised as an emerging sexually transmissible pathogen in men who have sex with men (MSM), causing sporadic outbreaks in countries where it is not endemic."[48]

In 2006, the The Medical Journal of Australia reported:

“  |  High rates of intestinal parasitism are found in MSM [men who have sex with men] throughout the world.

Amoebiasis has become endemic in MSM in Japan and causes significant morbidity and mortality; complications such as colitis and liver abscesses occur more frequently in homosexual and bisexual men than in heterosexual men. Similar findings on amoebiasis are reported from Taiwan, with MSM at increased risk for invasive amoebiasis and intestinal colonisation with E. histolytica.[49]

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In 2001, The journal Internal Medicine (Tokyo, Japan) published an article entitled Amebiasis in acquired immunodeficiency syndrome in which they declared:

“  |  While the overall prevalence of amebiasis is approximately 4% in the United States, certain high-risk groups have a much higher incidence of infection and disease. Prevalence of E. historylitica or E. dispar in the gay population of New York City and San Francisco approached 40-50% . Some Japanese literature also showed homosexual contact was an important risk factor for amebic infection.[50] |  ”

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Amebiasis is a disease caused by the one-celled parasite Entamoeba histolytica.

The 2004 article an entitled Present characteristics of symptomatic Entamoeba histolytica infection in the big cities of Japan which was published by the medical journal Epidemiology and Infection. The abstract for the article states the following:

“  |  Medical records, for 2000 and 2001, of symptomatic amoebic patients who were treated at our hospitals in Tokyo, Yokohama and Osaka were studied retrospectively for the purpose of gathering epidemiological data on symptomatic Entamoeba histolytica infection. A total of 58 patients were treated. Fifty-five of them were male, and 96% of the male patients were Japanese. The mean age of patients was 44.9 years old, and 91% of patients contracted the disease in Japan. Fifty-six per cent of the male patients indicated that they were practicing homosexuals, and 44% of the male patients denied these practices or left the question unanswered. The serum Treponema pallidum haemagglutination test was positive in 45% of the patients, and antibody to human immunodeficiency virus (HIV) was positive in 45%. Our study revealed that recent symptomatic E. histolytica infection almost exclusively afflicted middle-aged males in the big cities of Japan, that a majority of the patients were probably exposed to the causative organism during homosexual activity, and that an increasing number of patients will be co-infected with HIV. [51] |  ”

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In 1985, the peer reviewed medical journal Gut, which is an international medical journal for gastroenterology and hepatology, had an article entitled The Gay Bowel authored by I V Weller which stated the following: "Guardia lamblia and Entamoeba histolytica have long been regarded as 'exotic' organisms, but are 'hyperendemic' among gay men attending STD clinics with up to 20 excreting cysts."[52]

For more information, please see: Homosexuality and parasites

## See also[edit]

* Homosexuality and health
* Homosexuality

## References[edit]

1. ↑ http://www.mayoclinic.com/health/proctitis/DS00705
2. ↑ http://www.mayoclinic.com/health/proctitis/DS00705
3. ↑ http://www.umm.edu/ency/article/001139.htm
4. ↑ http://www.merck.com/mmhe/sec09/ch130/ch130f.html
5. ↑ http://www.mayoclinic.com/health/proctitis/DS00705
6. ↑ Sexually transmitted infections as a cause of proctitis in men who have sex with men, Davis TW1, Goldstone SE., Dis Colon Rectum. 2009 Mar;52(3):507-12. doi: 10.1007/DCR.0b013e31819ad537.
7. ↑ Sexually transmitted proctitis, E Hamlyn and C Taylor, Postgrad Med J. 2006 Nov; 82(973): 733–736. doi: 10.1136/pmj.2006.048488
8. ↑ Proctitis, Proctocolitis, and Enteritis, Centers for Disease Control and Prevention, 2015
9. ↑ http://www.cdc.gov/hiv/topics/msm/index.htm
10. ↑ http://www.lifesitenews.com/news/archive/ldn/2009/aug/09082609
11. ↑ Medscape - New Look at "Gay Bowel Syndrome"
12. ↑ 'Gay bowel syndrome': relic or real (and returning) phenomenon? by Cooper F1, Barber T., Current Opinion in Infectious Disease, 2014 Feb;27(1):84-9. doi: 10.1097/QCO.0000000000000032.
13. ↑ 'Gay bowel syndrome': relic or real (and returning) phenomenon? by Cooper F1, Barber T., Current Opinion in Infectious Disease, 2014 Feb;27(1):84-9. doi: 10.1097/QCO.0000000000000032., PubMed
14. ↑ Johns Hopkins HIV Guide, review of the literature - essentially duplicate of Medscape's New Look at Gay Bowel Syndrome, 2004, Wayback machine
15. ↑ The gay bowel syndrome: clinico-pathologic correlation in 260 cases.
16. ↑ Medscape - New Look at "Gay Bowel Syndrome"
17. ↑ Klausner JD, Kohn R, Kent C. Etiology of Clinical Proctitis among Men Who Have Sex with Men. Clinical Infectious Diseases 2004;38:300-302
18. ↑ http://www.springerlink.com/content/jx13231641717w48/
19. ↑ http://www.cdc.gov/hiv/resources/qa/qa22.htm
20. ↑ http://www.mayoclinic.com/health/proctitis/DS00705
21. ↑ http://www.umm.edu/ency/article/001139.htm
22. ↑ http://www.merck.com/mmhe/sec09/ch130/ch130f.html
23. ↑ The gay bowel syndrome: clinico-pathologic correlation in 260 cases.
24. ↑ http://www.mayoclinic.com/health/proctitis/DS00705/DSECTION=3
25. ↑ Medscape - New Look at "Gay Bowel Syndrome"
26. ↑ Syphilis & MSM (Men Who Have Sex With Men) - CDC Fact Sheet, taken from the CDC website on February 2, 2019
27. ↑ Homosexual Men Account for 65 Percent of Syphilis Cases, CDC Study Finds
28. ↑ Center for Disease Control - 2004
29. ↑ The gay bowel syndrome: clinico-pathologic correlation in 260 cases.
30. ↑ http://www.mayoclinic.com/health/proctitis/DS00705/DSECTION=3
31. ↑ Medscape - New Look at "Gay Bowel Syndrome"
32. ↑ Frequent Transmission of Gonorrhea in Men Who Have Sex with Men, Christopher K. Fairley,corresponding author Jane S. Hocking, Lei Zhang, and Eric P.F. Chow, Emerg Infect Dis. 2017 Jan; 23(1): 102–104. doi: 10.3201/eid2301.161205
33. ↑ Pharyngeal Gonorrhea Is Underdiagnosed in MSM, Am Fam Physician. 2007 Jun 15;75(12):1860-1862
34. ↑ Found citation at university website, material no longer at Concerned Women of America website
35. ↑ http://www.umm.edu/ency/article/001139.htm
36. ↑ Medscape - New Look at "Gay Bowel Syndrome"
37. ↑ The gay bowel syndrome: clinico-pathologic correlation in 260 cases.
38. ↑ Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case-control study in the U.K., Pallawela SN1, Sullivan AK1, Macdonald N2, French P3, White J4, Dean G5, Smith A6, Winter AJ7, Mandalia S2, Alexander S8, Ison C8, Ward H2., Sex Transm Infect. 2014 Jun;90(4):269-74. doi: 10.1136/sextrans-2013-051401. Epub 2014 Mar 31.
39. ↑ Lymphogranuloma venereum in Australia: anorectal Chlamydia trachomatis serovar L2b in men who have sex with men. J Clin Microbiol 2007 Mar;45(3):1029-31
40. ↑ Tidsskrift for den Norske laegeforening 2007 Aug 23;127(16):2094-5
41. ↑ Clinical infectious diseases 2007 Jan 1;44(1):26-32
42. ↑ Clinical infectious diseases 2007 Jan 1;44(1):26-32
43. ↑ Eurosurveillance 2006;11(9):152-4
44. ↑ Lymphogranuloma venereum in Australia: anorectal Chlamydia trachomatis serovar L2b in men who have sex with men. Eur J Clin Microbiol 2007 Mar;45(3):1029-31
45. ↑ The gay bowel syndrome: clinico-pathologic correlation in 260 cases.
46. ↑ http://www.umm.edu/ency/article/001139.htm
47. ↑ Medscape - New Look at "Gay Bowel Syndrome"
48. ↑ 'Outbreak of intestinal amoebiasis among men who have sex with men, Barcelona (Spain), October 2016 and January 2017, Eurosurveillance, 2017
49. ↑ Letter to the editor - Locally acquired infection with Entamoeba histolytica in men who have sex with men in Australia, Damien J Stark, Rashmi Fotedar, John T Ellis and John L Harkness, MJA 2006; 185 (8): 417
50. ↑ Amano K, Takeuchi T., Amebiasis in acquired immunodeficiency syndrome. Intern Med. 2001 Jul;40(7):563-4
51. ↑ Epidemiol Infect. 2004 Jan;132(1):57-60
52. ↑ I V Weller, The gay bowel, Gut. 1985 September; 26(9): 869–875