Gut Feeling

A 33 year old HIV positive man presents with lower abdominal discomfort, alternating diarrhea and constipation, rectal bleeding with a mucopurulent discharge, and tenesmus for 2 weeks.

He engages in regular anal intercourse with his male partner.

He is currently on highly active antiretroviral therapy (HAART). His CD4 count is 1158 cells/mm3, while the HIV viral load is <50 copies/mL.

Select Relevant Investigations
Lower GI Endoscopy

Performed

The rectum and sigmoid colon are inflamed. Multiple rectal ulcers are present.
Biopsy of an ulcer shows acute and chronic inflammatory cells, with a lymphoid infiltrate.
Stool Microscopy & Culture

Performed

No amoeba, ova or parasites are noted.
Cultures are negative.
Rectal Swab + NAAT

Performed

Positive for C. trachomatis
Negative for N. gonorrhoeae
HSV & Syphilis Screen

Performed

Rapid Plasma Reagin: nonreactive
HSV cultures: negative

Select Relevant Management
Azithromycin
Mesalazine
Doxycycline
Methylprednisolone