CHLAMYDIA PROCTITIS: A DIAGNOSTIC CHALLENGE AT THE INTERSECTION OF STIS AND INFLAMMATORY BOWEL DISEASES – CASE REPORT AND CLINICAL CONSIDERATIONS

The intersection between sexually transmitted infections (STIs) and gastrointestinal diseases is an emerging field in medicine, presenting significant diagnostic challenges. In this case report, we highlight a 30-year-old man who has sex with men (MSM) and uses PrEP, who presented with complaints of anal pain, the presence of blood and mucus in the stool for three weeks. He reported the last receptive anal intercourse with a condom 60 days ago with a fixed partner. The patient had been under outpatient care in gastroenterology for treatment of ulcerative colitis (UC) with mesalazine, without improvement in his clinical condition. A flexible sigmoidoscopy revealed mild distal ulcerative proctitis, and histopathological analysis showed intense active proctocolitis with ulcerations. Subsequently, an STI panel was performed, which tested positive for Chlamydia trachomatis (CT). CT infection is becoming increasingly common, especially among MSM and people living with HIV (PLHIV). Studies indicate that about 70% of chlamydia infections can go unnoticed if only urogenital tests are conducted in MSM. The typical clinical presentation of chlamydia infection usually involves cervicitis, urethritis, or can remain asymptomatic. However, in MSM who engage in anal sex, chlamydia can cause proctitis, characterized by tenesmus, hematochezia, and mucorrhea, mimicking symptoms of inflammatory bowel diseases (IBD). Accurate diagnosis can be challenging if a detailed sexual history is not conducted. In this context, polymerase chain reaction (PCR) plays a key role in diagnostic clarification, allowing sensitive and specific detection in rectal samples. This case highlights the importance of considering STIs, such as chlamydia, as a possible etiology for gastrointestinal symptoms in patients with high-risk sexual behavior. A comprehensive approach that is sensitive to the patient's sexual history is essential to guide accurate diagnosis and management, thereby avoiding delays in treatment and associated complications.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025