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Abstract：
This guideline intents to offer guidance on the diagnosis and management of patients with gastrointestinal symptoms and a suspected sexually transmitted cause. Proctitis is defined as an inflammatory syndrome of the anal canal and/or the rectum. Infectious proctitis can be sexually transmitted via genital-anal mucosal contact, but some also via digital contact and toys. Neisseria gonorrhoeae, Chlamydia trachomatis (including lymphogranuloma venereum), Treponema pallidum and herpes simplex virus are the most common sexually transmitted anorectal pathogens. Shigellosis can be transferred via oral-anal contact and may lead to proctocolitis or enteritis. Although most studies on these infections have concentrated on men who have sex with men (MSM), women having anal intercourse may also be at risk. A presumptive clinical diagnosis of proctitis can be made when there are symptoms and signs, and a definitive diagnosis when the results of laboratory tests are available. The symptoms of proctitis include anorectal itching, pain, tenesmus, bleeding, constipation and discharge in and around the anal canal. The majority of rectal chlamydia and gonococcal infections are asymptomatic and can only be detected by laboratory tests. Therefore, especially when there is a history of receptive anal contact, exclusion of anorectal infections is generally indicated as part of standard screening for sexually transmitted infections (STIs). Condom use does not guarantee protection from STIs, which are often spread without penile penetration. New in this updated guideline is: (i) lymphogranuloma venereum proctitis is increasingly found in HIV-negative MSM, (ii) anorectal Mycoplasma genitalium infection should be considered in patients with symptomatic proctitis after exclusion of other common causations such N. gonorrhoeae, C. trachomatis, syphilis and herpes, (iii) intestinal spirochetosis incidentally found in colonic biopsies should not be confused with syphilis, and (iv) traumatic causes of proctitis should be considered in sexually active patients.
摘要：
本指南旨在为胃肠道症状和可疑性传播原因的患者的诊断和管理提供指导。直肠炎定义为肛管和/或直肠的炎性综合征。感染性直肠炎可以通过生殖器-肛门粘膜接触性传播，但有些还通过数字联系和玩具。淋病奈瑟菌,沙眼衣原体（包括性病淋巴肉芽肿），梅毒螺旋体和单纯疱疹病毒是最常见的性传播肛门直肠病原体。志贺氏菌病可以通过口腔-肛门接触转移，并可能导致直肠结肠炎或肠炎。尽管大多数关于这些感染的研究都集中在男男性行为者（MSM）上，有肛交的女性也可能有风险。当出现症状和体征时，可以进行直肠炎的推定临床诊断，并在实验室检查结果可用时做出明确诊断。直肠炎的症状包括肛门直肠瘙痒，疼痛,重弹,出血,便秘和肛管周围的分泌物。大多数直肠衣原体和淋球菌感染是无症状的，只能通过实验室检测。因此,尤其是当有接受肛门接触的历史时，排除肛门直肠感染通常是性传播感染(STIs)标准筛查的一部分.使用避孕套不能保证免受性传播感染，通常在没有阴茎渗透的情况下传播。在这个更新的指南的新的是：（i）淋巴肉芽肿性直肠炎越来越多地发现在HIV阴性MSM，(ii)在排除其他常见原因如淋病奈瑟菌后，有症状直肠炎的患者应考虑肛门直肠支原体感染，C.沙眼，梅毒和疱疹,（iii）在结肠活检中偶然发现的肠螺旋体病不应与梅毒混淆，和(iv)性活跃患者应考虑直肠炎的创伤性原因。
