Background/introduction STIs are not routinely tested for in hospital which means they are often missed when they are an important differential diagnosis.
Aim(s)/objectives To present a case of rectal gonorrhoea (GC) in a patient with well-controlled Crohn’s disease (CD) who presented to gastroenterology before diagnosis of GC in GUM.
Methods Case report and literature review.
Case report A 37 year old man presented to gastroenterology with diarrhoea, abdominal pain, proctalgia and tenesmus. He was known to have CD which had been in remission with treatment. X-ray showed faecal impaction and he commenced laxatives. Bowels regularised but remained painful. He was discharged with topical diltiazem, lidocaine gel and Metronidazole. At follow up he reported continuing proctalgia and small amounts of rectal bleeding. Exploration under anaesthesia revealed a peri-anal fissure and a sinus which was de-roofed and treated with local anaesthetic. MRI showed an inflamed anal gland. Colonoscopy, biopsies and stool cultures were normal. He then attended sexual health as he recently found out his regular male partner had been unfaithful. Proctoscopy was painful and revealed discharge and inflamed anal mucosa. On microscopy > 10 neutrophils per high powered field were seen with a mixture of gram positive and negative organisms. Proctitis was treated with Doxycycline. Rectal GC tests were positive and this was treated. At test of cure symptoms had resolved and have not recurred since.
Discussion/conclusion Literature search reveals publications from recent years about STIs being initially misdiagnosed in hospital. This case further highlights the importance of asking routinely about partners in patients with bowel symptoms.