Enteric diseases of homosexual men

Pharmacotherapy (Impact Factor: 2.66). 01/1982; 2(1):32-42. DOI: 10.1002/j.1875-9114.1982.tb03170.x
Source: PubMed


Certain enteric ailments are particularly common among homosexual men. They are primarily infectious diseases and include not only such common venereal diseases as gonorrhea and syphilis but also infections not usually regarded as being sexually transmitted. Among the latter are shigellosis, salmonellosis, giardiasis, and amebiasis. Patients' symptoms are non-specific and seldom helpful in diagnosing particular diseases. The practitioner must be prepared to identify a number of infections with similar presentations that may occur singly or together in gay men. Gonorrhea is probably the most common bacterial infection in gay men. Carriage rates as high as 50% have been reported, and extra-genital carriage is common; this necessitates culturing the urethra, rectum, and pharynx. Procaine penicillin G is the treatment of choice for most patients; spectinomycin is probably the drug of choice in penicillin-sensitive patients. In contrast to other venereal diseases, syphilis may have a characteristic protoscopic presentation. Benzathine penicillin G is the treatment of choice for most patients. Lymphogranuloma venereum causes penile lesions and inguinal lymphadenitis in heterosexual men, whereas homosexual men are more prone to proctitis. The disease may mimic Crohn's disease. Recommended treatment includes tetracycline or sulfamethoxazole-trimethoprim. Shigellosis usually presents as an acute diarrheal illness. Patients generally require only supportive treatment with fluids. Herpes simplex viral infection is difficult to diagnose and has several different presentations, including lumbosacral radiculomyelopathy. Symptomatic treatment with sitz baths, anesthetic ointment, and analgesics is recommended. Venereal warts are believed to be caused by the same virus that causes verrucous warts; they are usually found in the anal canal or around the anal orifice. They are commonly treated with 25% podophyllin solution. Parasitic infections include giardiasis, amebiasis, and pinworm infections. Metronidazole may be used in the treatment of symptomatic giardiasis and amebiasis, but it is not approved for the former indication; quinacrine is approved for giardiasis. Pinworm infestation may be treated with pyrantel pamoate or mebendazole. Cure of enteric diseases in homosexual men must be documented.

1 Follower
23 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Enterobius vermicularis (pinworm) is a tiny helminth that lives in the human cecum. Its prevalence varies widely by region and institutional setting. Prevalence greater than 70 percent has been reported among Asian children in orphanages and adults at autopsy after sudden death. In other settings, pinworm infection is rare. Pinworm is diagnosed relatively easily with a perianal sticky tape test and microscope visualization of eggs or worms. Treatment also is straightforward using pyrantel pamoate, mebendazole, or albendazole once and repeated in 2 weeks. Eggs persist in home or institutional environments and can reinfect. Serious sequelae are not thought to be common, but they can include peritonitis, mesenteric abscess, intestinal perforation, enteric ulceration, enteritis, Meckel diverticulitis, and intussusception from ectopic worm movement. More controversial is the association of pinworm with appendicitis, urinary tract infection, and enuresis; evidence for and against these associations is discussed in the review. Pediatricians encounter pinworm in varying frequencies depending on local environmental dynamics, but this pathogen must be considered on a daily basis worldwide for a wide variety of potential manifestations. Copyright © 2000 by W.B. Saunders Company
    No preview · Article · Oct 2000 · Primary Care Clinics in Office Practice
  • [Show abstract] [Hide abstract]
    ABSTRACT: This book is a compelling and balanced history of the California missions and their impact on the Indians they tried to convert. Focusing primarily on the religious conflict between the two groups, it sheds new light on the tensions, accomplishments, and limitations of the California mission experience. James A. Sandos, an eminent authority on the American West, traces the history of the Franciscan missions from the creation of the first one in 1769 until they were turned over to the public in 1836. Addressing such topics as the singular theology of the missions, the role of music in bonding Indians to Franciscan enterprises, the diseases caused by contact with the missions, and the Indian resistance to missionary activity, Sandos not only describes what happened in the California missions but offers a persuasive explanation for why it happened.
    No preview · Article · Jan 2004
  • [Show abstract] [Hide abstract]
    ABSTRACT: Enterobius vermicularis has the broadest geographic range of any helminth and is the most common intestinal parasite seen in the primary care setting. Underappreciated is the fact that it is not always a benign disorder and could even cause life-threatening medical problems. Visualization of the actual worms during endoscopy is probably underappreciated in part because endoscopists have never actually seen the worm and/or are not actively looking for, or anticipating, worms. This report describes a case of worm infection as documented during colonoscopy and confirmed by microscopy. The gross and microscopic appearance of the worm is described. Literature regarding the wide range of gastrointestinal and nongastrointestinal manifestations, including potentially life-threatening illnesses, as well as treatment options, are also reviewed.
    No preview · Article · Oct 2005 · Southern Medical Journal