Misdiagnosis and MSM: A Systematic Review Assessing the Diagnosis of IBD and Sexually Transmitted Infectious Colitis in Gay Men

Document Type

Conference Proceeding

Publication Date

10-25-2023

Publication Title

Am J Gastroenterol

Abstract

Introduction: Diagnosing IBD in men who have sex with men (MSM) is difficult due to its resemblance to sexually transmitted infection (STI) colitis. Outbreaks of lymphogranuloma venereum (LGV) colitis have been rising in Western nations. Misdiagnosis of IBD in MSM has been documented in various studies. While infectious disease guidelines recommend testing patients based on sexual activity, there remain no guides for STI tests prior to diagnosing IBD in MSM. This study aims to ascertain the factors in the misdiagnosis of MSM presenting with colitis to improve inherent health disparities. Methods: A systematic review was conducted using MEDLINE, PubMed, and Scopus. Studies included misdiagnosis of IBD or STI colitis in MSM and identified race, age, sexual preference and diagnostic methods. Studies were from North America or Europe with 1 Israeli retrospective study and 1 Korean case report. Initial and final diagnosis, diagnosis location, endoscopic and biopsy findings were collected. Results: 73 publications were found between 1985-2023 mentioning IBD and STI colitis in MSM. 19 articles were included, with 2 retrospective studies, 1 prospective study, 7 case series and 9 case reports. N=63 MSM were included with a mean age of 38. All had an initial diagnosis of IBD either from endoscopic or biopsy evidence. Time to an STI diagnosis ranged from 7 days to 3 years. N=51 were HIV positive. N=54 were found to have LGV with 8 co-infected with either syphilis and/or gonorrhea. N=4 had syphilitic colitis, N=2 had Kaposi sarcoma, N=1 had amebiasis and N=1 had CMV colitis. N=26 received an aminosalicylate (N=22), oral steroid (N=11), hydrocortisone enema (N=6), or biologic (N=3) with failure before an investigation of STI colitis. Most IBD diagnoses took place at primary, colorectal surgery or GI clinics. STI colitis diagnoses were primarily made at ID or GI clinics. Nearly all patients treated with antibiotics had symptom resolution. Conclusion: This review is the first of its kind to compile data on the misdiagnosis of IBD in MSM. A limitation is the heterogeneous nature of the studies. Regardless, misdiagnosis and inappropriate treatment may occur when not considering sexual history or HIV status. This underscores the difficulty of these diagnoses even with serologies, endoscopy and biopsy, especially with rising numbers of LGV and syphilis in a relatively young MSM population. Instituting STI testing guidelines before diagnosing IBD in MSM may decrease the risk of misdiagnosis and can improve quality of care.

Volume

118

Issue

10

First Page

S775

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