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