Sexually transmitted infectious colitis vs inflammatory bowel disease: distinguishing features from a case-controlled study.
OBJECTIVE
Sexually transmitted infectious (STI) colitis often raises concern for inflammatory bowel disease (IBD). In this study, we compare histologic features of IBD with STI colitis caused by syphilis and lymphogranuloma venereum.


METHODS
The STI colitis group included 10 unique colorectal biopsy specimens in patients with clinically confirmed syphilis and/or lymphogranuloma venereum. The STI biopsy specimens were compared with patients matched for age, sex, and site with Crohn disease (n = 10) or ulcerative colitis (n = 10). All IBD controls had an established history of IBD (up to 276 months of follow-up, mean follow-up = 102 months).


RESULTS
Discriminating features (P < .05) of STI colitis included its exclusive identification in human immunodeficiency virus-positive men who have sex with men, anal pain, and anal discharge. STI colitis contained the triad of (1) minimal active chronic crypt centric damage, (2) a lack of mucosal eosinophilia, and (3) submucosal plasma cells, endothelial swelling, and perivascular plasma cells. Nondiscriminating features (P > .05) included rectal bleeding, endoscopic appearance, skip lesions, ulcerations, aphthoid lesions, granulomata, foreign body giant cells, neural hyperplasia, fibrosis, and lymphoid aggregates.


CONCLUSIONS
While STI colitis shares many overlapping features with IBD, histologic and clinical discriminating features may be helpful when confronted with that differential diagnosis.
From the Departments of Pathology.
Christina A
CA
Arnold
From the Departments of Pathology.
Rachel
R
Roth
Gastroenterology, Hepatology, and Nutrition and.
Razvan
R
Arsenescu
Surgery, The Ohio State University Wexner Medical Center, Columbus;
Alan
A
Harzman
Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ;
Dora M
DM
Lam-Himlin
Department of Medicine, Stanford University, Stanford, CA and.
Berkeley N
BN
Limketkai
Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD.
Elizabeth A
EA
Montgomery
Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD. lvoltag1@jhmi.edu.
Lysandra
L
Voltaggio
D000328:Adult; D016022:Case-Control Studies; D003092:Colitis / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D003937:Diagnosis, Differential; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis* / Q000473:pathology; D008219:Lymphogranuloma Venereum / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D012007:Rectum / Q000473:pathology; D013587:Syphilis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology
Centers for Disease Control and Prevention; Crohn disease; Human immunodeficiency virus; Inflammatory bowel disease; Lymphogranuloma venereum; Men who have sex with men; Sexually transmitted infectious colitis; Syphilis; Ulcerative colitis