Gonorrhoe, Lues, Chlamydien, Mykoplasmen und Ureaplasmen aus proktologischer Sicht

Sexual transmitted diseases (STD) and infections (STI) play an important role in the treatment of proctological patients. In particular, the incidences of gonorrhea, Chlamydia and syphilis are regionally very different and sometimes greatly increasing.

The currently most important facts for the clinical practice as well as possible and recommended treatment options in patients with gonorrhea, syphilis, Chlamydia, Mycoplasma and Ureaplasma infections are presented. The advantages and disadvantages of the diagnostics with the multiplex polymerase chain reaction (PCR) are also presented.

The current guidelines, selected original articles, meta-analyses and expert opinions are assessed and discussed taking own experience and recommendations into account as well as documentation with pictures.

Multiplex PCR is a highly sensitive diagnostic tool, which, however, does not distinguish between infection and colonization, so that caution is advised in this respect and the clinical symptoms must be taken into account. This is especially true if this method is used for screening. Whereas gonorrhea and Chlamydia are symptomatic as proctitis with the typical symptoms of mucopurulent discharge, bleeding, tenesmus, feeling of incomplete emptying, foreign body sensation or pressure, syphilis with its four stages represents a separate entity. The hard ulcer of primary syphilis can be uncharacteristically painful in the anal area. The diagnosis of syphilis is confirmed or made serologically. In contrast to urology and gynecology, Mycoplasma hominis and Ureaplasma do not play a role in proctology and should be ignored in the case of an isolated detection in the anorectal area.