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Case records of the Massachusetts General Hospital. Case 2-2006. A 31-year-old, HIV-positive man with rectal pain.

Davis BT, Thiim M, Zukerberg LR. N Engl J Med 2006 Jan 19;354(3):284-9.

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Reviewed by Susa Coffey, MD

Summary

In the past several years, clustered cases of lymphogranuloma venereum (LGV) in men who have sex with men (MSM) in the United States and Europe have focused attention on an infection that had been thought to be rare in this country. LGV is caused by Chlamydia trachomatis serovars L1, L2, and L3, and, as with other C trachomatis serotypes, is transmitted sexually. It usually presents as lymphadenitis; if the primary site of infection is the rectum, it usually manifests as proctitis with or without systemic symptoms.

This article presents a case study of an HIV-infected MSM who presents with symptoms of proctitis. It illustrates the clinical presentation, differential diagnosis, and evaluation of proctitis, and discusses the treatment of LGV.

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