Anorectal Gonococcal Infection

Abstract

Anorectal [Neisseria gonorrhoeae] gonococcal infection is common in women and homosexual men. In women with uncomplicated gonorrhea, the mean prevalence rate of anorectal involvement is 44%, with lone involvement of the anorectum in 4%. Among homosexual men with gonorrhea, anorectal infection occurs in 45%, although > 90% of all male patients with anorectal gonorrhea admit to homosexual rectal intercourse. This infection is usually asymptomatic but occasionally presents with acute or chronic symptoms that mimic other causes of proctitis. Whereas currently recommended regimens for uncomplicated gonorrhea appear effective for anorectal gonorrhea in women, results in men have not been adequately evaluated. Available data showed failure rates from 7-35%, but only 1 study used a currently accepted regimen. Further controlled studies in male patients with anorectal gonorrhea are clearly needed to establish optimal therapeutic regimens. Diligent contact tracing of all male homosexual cases appears to be the only effective means of control at present.