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Proctitis Diagnosis After Unprotected Sex

A 25-year-old man presents with rectal pain and bleeding after unprotected sexual intercourse, and proctoscopy reveals a rectal ulcer. The most likely diagnosis is Lymphogranuloma venereum, caused by specific serovars of Chlamydia trachomatis, which is recognized as a cause of proctitis. Recommended treatment is doxycycline.

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2 views1 page

Proctitis Diagnosis After Unprotected Sex

A 25-year-old man presents with rectal pain and bleeding after unprotected sexual intercourse, and proctoscopy reveals a rectal ulcer. The most likely diagnosis is Lymphogranuloma venereum, caused by specific serovars of Chlamydia trachomatis, which is recognized as a cause of proctitis. Recommended treatment is doxycycline.

Uploaded by

nomanaslam3003
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd

Question 98 of 100 LOG OUT 

0:42:20/03:00:00

A 25-year-old man presents to the Emergency Department with rectal pain associated with passage of blood Difficulty: Average
and mucus. He admits to unprotected sexual intercourse with three men over the past three weeks.
Proctoscopy reveals a rectal ulcer. Peer Responses %

Investigation Result Normal value

Haemoglobin (Hb) 132 g/l 115–155 g/l

White cell count (WCC) 7.0 × 10 9/l 4–11 × 10 9/l

Platelets (PLT) 191 × 10 9/l 150–400 × 10 9/l

C-reactive protein (CRP) 32 mg/l < 10 mg/l

Potassium (K +) 3.0 mmol/l 3.5–5.0 mmol/l

Creatinine (Cr) 75 µmol/l 50–120 µmol/l Q. Answered Flagged

Q1
What is the most likely diagnosis?
Q2
Your answer was correct
Q3

A Chancroid Q4

Q5
B Donovanosis
Q6

C Inflammatory bowel disease Q7

Q8
D Lymphogranuloma venereum
Q9 

E Mycobacterium chimaera infection


Explanation 
Chlamydia


D Lymphogranuloma venereum

This patient has proctitis with ulceration following unprotected anal intercourse. Lymphogranuloma venereum
is caused by the L1, L2 or L3 serovars of Chlamydia trachomatis and is recognised as a cause of proctitis.
Unlike standard chlamydia infection, which affects squamocolumnar epithelial cells, these serovars infect Media Expanded Flashcards
explanations
mononuclear phagocytes. Around 1% of rectal swabs of men who have sex with men and attend a Sexual
Health Clinic are positive for L1, L2 or L3 C. trachomatis. Doxycycline is the recommended intervention.

A Chancroid

Chancroid is a rare cause of sexually transmitted infection in the United Kingdom and Europe and is caused by
Haemophilus ducreyi. Treatment options include single doses of azithromycin or ceftriaxone.

B Donovanosis

Donovanosis is a tropical sexually transmitted infection, also known as granuloma inguinale. It is recognised as
a cause of anal ulceration.

C Inflammatory bowel disease

Inflammatory bowel disease is unlikely here, given the proximity to unprotected sexual intercourse. In active
ulcerative colitis, a greater rise in CRP level might also be expected.

E Mycobacterium chimaera infection

Mycobacterium chimaera infection is a low-virulence Mycobacterium which primarily leads to infection after
cardiac valve surgery. The risk of being infected with this has been linked to a device used to heat and cool the
blood during some types of heart surgery, making it unlikely in this patient.
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