Human intestinal spirochetosis: a sexually transmitted disease?

  • Garcia-Hernandez D & al.
  • Int J STD AIDS
  • 24.11.2020

  • von Liz Scherer
  • Clinical Essentials
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Takeaway

  • Human intestinal spirochetosis (HIS) may be sexually transmitted, especially in men who have sex with men (MSM).

Why this matters

  • HIS may need to be included in differentials for MSM and people living with HIV who present with chronic diarrhea.
  • Inquire about history of condomless anal or oro-anal sex during initial consultation.

Key results

  • Case series of 6 MSM with HIS, 3 of them also living with HIV.
  • Median age at diagnosis: 31.5 (interquartile range, 29.5-49.25) years.
  • 1 had concomitant Chlamydia trachomatis (nonlymphogranuloma venereum) and 2 had rectal gonorrhea.
  • In past 6 months: 5 reported condomless anal intercourse, 4 oro-anal intercourse.
  • Predominant symptoms: diarrhea (5), anal discharge (2), abdominal pain (2), anal bleeding (2), flatulence (2).
  • Diagnosis: by Warthin-Starry stain, mild inflammatory changes were seen in 5.
  • 5 were treated with oral metronidazole:
    • 4 received 250 mg 3 times a day for 14 days. 
    • 1 received 500 mg twice a day for 7 days, in the context of concomitant giardiasis.
  • 1 received intramuscular benzathine penicillin G, 2.4 million units.
  • HIS resolved in all 6.

Study design

  • Retrospective, descriptive case series of patients with HIS diagnosed 2009-2018 at sexually transmitted infections centers in Barcelona, Spain.
  • Funding: None.

Limitations

  • Case series. 
  • Generalizability unknown.