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O14.4 Enteric and sexually acquired pathogens in men who have sex with men with clinical proctitis
  1. E Chow1,2,3,
  2. D Lee4,
  3. S Bond2,
  4. C Fairley1,2,
  5. K Maddaford2,
  6. R Wigan2,
  7. G Fehler2,
  8. S Lange4,
  9. V De Petra4,
  10. M Bissessor2,
  11. C Bradshaw1,2,3,
  12. B Howden4,
  13. J Hocking3,
  14. D Williamson4,5,
  15. M Chen1,2
  1. 1Central Clinical School, Monash University, Melbourne, Australia
  2. 2Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
  3. 3Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
  4. 4Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
  5. 5Department of Microbiology, Royal Melbourne Hospital, Melbourne Health, Melbourne, Australia


Background Rectal infections are common in men who have sex with men (MSM) and may increase HIV risk. This study aimed to identify enteric and sexually acquired rectal pathogens, other than chlamydia and gonorrhoea, associated with symptomatic proctitis in MSM.

Methods Anorectal swab samples were obtained from MSM presenting with rectal symptoms and a clinical diagnosis of proctitis at the Melbourne Sexual Health Centre between January-2017 and March-2019. Samples that tested positive for Neisseria gonorrhoeae and Chlamydia trachomatis were excluded. As a comparison group, anorectal samples were also obtained from MSM not reporting symptoms of proctitis between November-2018 and February-2019. Samples from both groups were tested for 15 viral, bacterial and protozoal enteric pathogens including Shigella spp., Treponema pallidum, Mycoplasma genitalium and herpes simplex virus (HSV) using PCR.

Results Anorectal samples from 499 men with symptomatic proctitis and 506 asymptomatic men were analysed. Age, HIV status and PrEP use did not differ between men with proctitis and asymptomatic men. Among men with proctitis, 38% were HIV negative and taking HIV PrEP and 16% were HIV-positive. T. pallidum was more common in men with proctitis compared to asymptomatic men (3.6% vs 0%, risk difference [RD]=3.6%, 95%CI:2.0–5.2%). Most men with anorectal T. pallidum presented with painful anal primary infections. Shigella spp. was more common in men with proctitis (2.8% vs 1.0%, RD=1.8%, 95%CI:0.1–3.5%). Most men with Shigella did not report diarrhoea. M. genitalium was more common in men with proctitis (9.4% vs 5.1%, RD=4.3%, 95%CI:1.1–7.5%). HSV-1 (12.6% vs 2.6%, RD=10.1%; 95%CI:6.8–13.3%) and HSV-2 (8.8% vs 1.6%, RD=7.2%; 95%CI:4.5–10.0%) were more common in men with proctitis.

Conclusion Testing for Shigella and T. pallidum should be considered in MSM presenting with symptomatic proctitis. These data provide support for M. genitalium as a significant cause of proctitis.

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