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EDITOR’S QUIZ: GI SNAPSHOT

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From question on page 943

Rectal biopsies showed lymphoid follicle hyperplasia and diffuse inflammatory infiltrate with lymphocytes and neutrophils. Enzyme immunoassay of chlamydial antigens in the rectal biopsies and specific serum immunoglobulin G antibodies revealed Chlamydia trachomatis infection. Her partner also had C trachomatis urethritis. A diagnosis of C trachomatis proctitis was made. Her symptoms improved with oral minocycline for two weeks. Follow up colonoscopy two months later showed that granular proctitis had completely healed without scar formation.

Sexually transmitted gastrointestinal syndromes, caused by C trachomatis, Treponema pallidum, Neisseria gonorrhoeae, Entamoeba histolytica, and herpes simplex virus, include proctitis and proctocolitis. Unprotected anal intercourse may increase the risk of this infection. C trachomatis causes trachoma, oculogenital infections, and lymphogranuloma venereum in humans. The word trachomatis is derived from the Greek word, translated as roughness, and refers to the characteristic conjunctival follicles, which have a similar appearance to granular proctitis.

In conclusion, sexually transmitted proctitis should be included in the differential diagnosis of anorectal inflammation and a careful history may provide important clues to direct appropriate specimen collection.

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