We present the case of a 41-yr-old homosexual man who was managed for suspected rectal cancer before lymphogranuloma venereum was clinically diagnosed. At first, he presented with constipation and tenesmus for several days. Upon rectal examination, the mass was palpated at 3 cm from the anal verge. Colonoscopy revealed a tumor of lower rectum, but multiple endoscopic biopsies were unable to reveal the nature of the tumor, so the pathologist just gave the diagnosis of a rectal pseudo-tumor. Positive chlamydial serology was found, and the final diagnosis was made. He was treated for Chlamydia trachomatis with Doxycycline, 100 mg twice daily for 21 days.
Biopsy ; Chlamydia trachomatis ; Colonoscopy ; Constipation ; Doxycycline ; Homosexuality ; Humans ; Lymphogranuloma Venereum ; Male ; Rectal Neoplasms ; Rectum

Cutaneous Diseases of the External Genitalia. The patients with cutaneous diseases of the external genitalia are usually concerned about a presence of sexually transmitted diseases, but other cutaneous diseases of inflammatory or autoimmune origin also present as cutaneous diseases of the external genitalia. The commonly found cutaneous diseases of the external genitalia are inflammatory diseases, such as contact dermatitis, psoriasis, Reiter's syndrome, Lichen planus, seborrheic dermatitis, balanitis, and balanoposthitis. Also sexually transmitted diseases are mainly composed of syphilis, genital herpes, lymphogranuloma venereum, condyloma, and molluscum contagiosum. The sexual partners of these sexually transmitted diseases need treatment at the same time. Fungal diseases, such as tinea and candidiasis also occur in genital areas and need careful diagnosis. Autoimmune diseases, such as Behcet's disease, also manifest as ulcerative lesions in the genital areas.
Autoimmune Diseases ; Balanitis ; Candidiasis ; Dermatitis, Contact ; Dermatitis, Seborrheic ; Genitalia ; Herpes Genitalis ; Humans ; Lichen Planus ; Lymphogranuloma Venereum ; Male ; Molluscum Contagiosum ; Psoriasis ; Sexual Partners ; Sexually Transmitted Diseases ; Syphilis ; Tinea ; Ulcer

PURPOSE: Chlamydia trachomatis(CT) infection is the most common bacterial sexually transmitted disease. Because of vague symptoms and delayed diagnosis, untreated infection can be transmitted to sexual partners and progress to infertility, pelvic inflammatory disease and ectopic pregnancy. Genotyping and serotyping for CT are very important to establish contact networks and for epidemiological and evolutionary studies. Cryptic plasmid and omp1 genes are targets for the detection of CT. Although the plasmid is a good target for amplification, it is very difficult to analyze sequences from the plasmid amplicons. The omp1 gene is an ideal target for sequence analysis because of large and publicized data deposits on the internet. However, very few studies have been published using a polymerase chain reaction(PCR) for the detection of the chlamydial omp1 gene in Korea. The purpose of this study was to detect CT infection with semi-nested amplification of the chlamydial omp1 gene. MATERIALS AND METHODS: Genomic DNA was extracted from the urethral swabs of 20 patients with urethritis or idiopathic chronic prostatitis, and from the vaginal swabs of 80 patients attending the gynecology clinic due to various vaginal symptoms. The primers were designed on omp1 genes from 12 CT and 2 sequences of lymphogranuloma venereum. The estimated products from the first and second rounds of PCR were 656 and 100 bp, respectively. RESULTS: With the 1st PCR bands there were confusing and non-specific bands, but all the specific PCR products from the 1st and 2nd amplifications with new primer sets were identified. CT was identified in 2 of 20 male patients (10%) and 4 of 80 female patients (5%). CONCLUSIONS: CT infections were detected from patients with semi-nested amplifications of the chlamydial omp1 gene. The semi-nested PCR method may be a more sensitive and specific test than first round PCR.
Chlamydia trachomatis* ; Chlamydia* ; Delayed Diagnosis ; DNA ; Female ; Gynecology ; Humans ; Infertility ; Internet ; Korea ; Lymphogranuloma Venereum ; Male ; Pelvic Inflammatory Disease ; Plasmids ; Polymerase Chain Reaction* ; Pregnancy ; Pregnancy, Ectopic ; Prostatitis ; Sequence Analysis ; Serotyping ; Sexual Partners ; Sexually Transmitted Diseases, Bacterial ; Urethritis

Screening and detecting sexually transmitted diseases (STDs) is a form of secondary prevention, which interrupts further transmission as well as progression of the infection and its sequelae. Unfortunately, primary prevention, by means of education and taking safe sex partners, has not been enough to significantly curb the prevalence and high cost of STDs. Bacterial STDs are decreasing in their prevalence whereas the prevalence of viral STDs has increased significantly in recent years. The differential diagnosis for genital ulcers, urethritis, and genital warts is very important. For example, syphilis, chancroid, lymphogranuloma venereum, and herpes simplex for genital ulcer are mistaken for other causes such as Behcet's syndrome, drug eruption, erythema multiforme, amebiasis, trauma, and carcinoma. Confirmatory testings made by cultures, PCR, or serologic studies are important for appropriate treatment and eradication of the disease in both patients and their partners. The physicians treating STDs should make special efforts to be sure that his or her methods of diagnosis and treatment reflect the latest knowledge, since the epidemiologic characteristics and treatment trends are rapidly changing based on newly appearing resistant strains.
Amebiasis ; Behcet Syndrome ; Chancroid ; Condylomata Acuminata ; Diagnosis, Differential ; Drug Eruptions ; Erythema Multiforme ; Genitalia ; Herpes Simplex ; Humans ; Lymphogranuloma Venereum ; Mass Screening ; Methylmethacrylates ; Polymerase Chain Reaction ; Polystyrenes ; Prevalence ; Primary Prevention ; Safe Sex ; Secondary Prevention ; Sexually Transmitted Diseases ; Syphilis ; Ulcer ; Urethritis

Adult ; Base Sequence ; Biopsy ; Chlamydia Infections ; complications ; Chlamydia trachomatis ; genetics ; isolation & purification ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphogranuloma Venereum ; etiology ; Molecular Sequence Data ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length

We report the case of a 20-year-old man with a 2-month history of anal pain and bloody rectal discharge. He was referred to our clinic of gastroenterology for suspected inflammatory bowel disease (IBD). The colonoscopy showed mucosal nodularities on the rectum and an anal tag. Because the colonoscopic findings were not consistent with the typical manifestations of IBD, we took an additional sexual history and performed studies for infectious proctitis, including serologic tests for Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum. He had homosexual experience, and the serologic tests and PCR of a rectal swab were positive for C. trachomatis infection. Finally he was diagnosed as having chlamydial proctitis and was treated with intramuscular ceftriaxone 250 mg in a single dose and doxycycline 100 mg orally twice daily for 7 days. After 2 months, he had no lower abdominal symptoms and his endoscopic findings were improved.
Ceftriaxone ; Chlamydia trachomatis ; Colonoscopy ; Doxycycline ; Gastroenterology ; Homosexuality ; Humans ; Inflammatory Bowel Diseases ; Lymphogranuloma Venereum ; Male ; Neisseria gonorrhoeae ; Polymerase Chain Reaction ; Proctitis ; Rectum ; Serologic Tests ; Sexually Transmitted Diseases ; Treponema pallidum ; Young Adult