In virtually every mammal, chlamydiae strains persist in the gastro-intestinal tract for long periods of time in the absence of apparent inflammation and pathology. Although anorectal Chlamydia trachomatis (CT ) infections are diagnosed frequently in women and men who have sex with men, their detection often remains unexplained as anal sex is not always reported. Oropharyngeal infections and the gastro-intestinal tract may contribute to the explanation. Both symptomatic and asymptomatic chlamydial pharyngitis has been described. Consequentially, the pathogen may pass through the gastro-intestinal tract to the large intestine and rectum, inducing chlamydia proctitis, and ongoing transmission. Oro-anal transmission might also explain the asymmetric distribution of diagnosed anorectal and urogenital lymphogranuloma venereum infections among men who have sex with men as found in the current epidemic. Recently the use of saliva as lubricant for anal sex has been proposed as alternative (oro-anal) route for gonorrhoea transmission in MSM. It can be deduced that this mode of transmission further contributes to the exceeding numbers of anorectal LGV infections as opposed to genital infections.
Disclosure No significant relationships.
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