Sexually Transmitted Enteric Disorders
Substantial increases in the recognition and prevalence of sexually transmitted enteric disorders have occurred over the past several decades, largely due to increasing freedom of both heterosexual and homosexual expression. The acquired immunodeficiency syndrome (AIDS) has further augmented the diversity and complexity of sexually related enteric disorders. These disorders are summarized in Table 42-1. Gastrointestinal and hepatobiliary disorders that are related to the human immunodeficiency virus (HIV) are discussed in more detail in Chapter 43.
I. PATHOGENESIS.
Most of the sexually related enteric disorders are infectious (Table 42-1), although trauma may be a clinically significant factor in the pathogenesis of anorectal disease, and neoplasm (Kaposi’s sarcoma, lymphoma) can complicate AIDS. The transmission of infectious agents during sexual activity is to be expected, particularly when one considers the variety of means of sexual expression—oral/oral contact, fellatio, cunnilingus, anilingus, and anal intercourse, in addition to ordinary sexual intercourse. Thus, it is no mystery that sexually related diseases occur, particularly in the oropharynx and anorectum, but also elsewhere throughout the digestive system.
II. DIAGNOSIS.
Knowledge of a patient’s sexual practices can be helpful but is not necessary to make an etiologic diagnosis of one of the conditions listed in Table 42-1.
TABLE 42-1 Sexually Related Disorders of the Gastrointestinal Tract | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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A. Oropharyngeal disorders
1. Gonococcal pharyngitis
can present with sore throat, exudate of the pharynx and tonsils, and ulcerations of the tongue and buccal mucosa. However, some patients with gonococcal infection of the oropharynx may be asymptomatic but transmit the disease to others. If gonococcal infection is suspected, the lesions should be cultured immediately.
2. Syphilis.
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