Chlamydial Proctitis

A 26-year-old man presented with a week of fevers and bloody stools following condomless receptive anal intercourse with a new male partner. Physical exam revealed only a small external hemorrhoid, with no abdominal pain or lymphadenopathy. CT imaging showed rectal wall thickening and perirectal lymphadenopathy. Flexible sigmoidoscopy revealed nodular erythematous mucosa with ulceration; biopsy ruled out malignancy. A nucleic acid amplification test confirmed Chlamydia trachomatis, negative for L serovars. Additional STI screening showed new HIV diagnosis (CD4 count: 551/mm³; viral load: 129,000 copies/mL). Treatment with doxycycline and antiretroviral therapy led to complete symptom resolution within five days.

A 26-year-old man presented with a week of fevers and bloody stools following condomless receptive anal intercourse with a new male partner. Physical exam revealed only a small external hemorrhoid, with no abdominal pain or lymphadenopathy. CT imaging showed rectal wall thickening and perirectal lymphadenopathy. Flexible sigmoidoscopy revealed nodular erythematous mucosa with ulceration; biopsy ruled out malignancy. A nucleic acid amplification test confirmed Chlamydia trachomatis, negative for L serovars. Additional STI screening showed new HIV diagnosis (CD4 count: 551/mm³; viral load: 129,000 copies/mL). Treatment with doxycycline and antiretroviral therapy led to complete symptom resolution within five days.