Infecciones entéricas: tratamiento, causas, síntomas, diagnóstico y prevención

Las personas que practican sexo anal o relaciones sexuales en las que realizan contacto oral-fecal, pueden presentar proctocolitis y enteritis (capítulos 91 y 94). Entre los posibles agentes patógenos causales destacan Campylobacter, Shigella, Entamoeba histolytica, C. trachomatis (serotipos del LGV) y Giardia lamblia. Así mismo, los pacientes infectados por el VIH pueden presentar infecciones a partir de agentes que normalmente no se transmiten por vía sexual, como citomegalovirus, Mycobacterium avium-intracellular, Salmonella, Cryptosporidium, Microsporidium e Isospora.9

Síntomas

Los síntomas de la proctocolitis son dolor anorrectal, tenesmo, secreciones rectales, diarrea y calambres abdominales. Los pacientes con enteritis presentan calambres abdominales y diarrea, pero sin signos de proctocolitis.

Diagnóstico

Se realiza mediante las pruebas y métodos diagnósticos apropiados, como anoscopia, sigmoidoscopia, examen de las heces y coprocultivo. En ocasiones resulta necesario obtener múltiples muestras de heces para realizar el diagnóstico de infestación por Giardia; así mismo, para el diagnóstico de la criptosporidiosis y la microsporidiosis son necesarias preparaciones especiales.9

Tratamiento

El tratamiento depende del diagnóstico específico.

Prevención

El seguimiento depende del diagnóstico. Hay que informar a los pacientes acerca del mecanismo de transmisión de su infección. Hay que visitar a los compañeros sexuales, valorarlos y tratar si está indicado.

Bibliografía

1. Centers for Disease Control and Prevention. Summary of notifiable diseases, United States 1994. MMWR 1994; 43: 29-30,56-7.

2. Handsfield HH. Recent developments in STDS. I. Bacterial diseases. Hosp Pract (Off Ed) 1991; 26: 47-56.

3. Christmas JT, Wendel GD, Bawdon RE, Farris R, Cartwright G, Little BB. Concomitant infection with Neisseria gonorrhoeae and Chlamydia trachomatis in pregnancy. Obstet Gynecol 1989; 74: 295-8.

4. Aral SO, Holmes KK. Sexually transmitted diseases in the AIDS era. Sci Am 1991; 264: 62-9.

5. Piot P, Islam MQ. Sexually transmitted diseases in the 1990s: global epidemiology and challenges for control. Sex Transm Dis 1994; 21 Suppl 2: S7-13.

6. Centers for Disease Control and Prevention. Recommendations for the prevention and management of Chlamydia trachomatis infections, 1993. MMWR 1993; 42 RR-12: 1-32.

7. Kassler WJ, Cates W Jr. The epidemiology and prevention of sexually transmitted diseases. Urol Clin North Am 1992; 19: 1-12.

8. Kellogg JA. Impact of variation in endocervical specimen collection and testing techniques on frequency of false-positive and false-negative Chlamydia detection results. Am J Clin Pathol 1995; 104: 554-9.

9. Centers for Disease Control and Prevention. 1993 Sexually transmitted diseases treatment guidelines. MMWR 1993; 42: 3-102.

10. Brunham RC, Paavonen J, Stevens CE, et al. Mucopurulent cervicitis-the ignored counterpart in women of urethritis in men. N Engl J Med 1984; 311:1-6.

11. Turrentine MA, Newton ER. Amoxicillin or erythromycin for the treatment of antenatal chlamydial infection: a metaanalysis. Obstet Gynecol 1995; 86: 1021-5.

12. Centers for Disease Control and Prevention. Increasing incidence of gonorrhea-Minnesota, 1994. MMWR 1995; 44: 282-5.

13. Laga M, Manoka A, Kivuvu M, et al. Non-ulcerative sexually transmitted diseases as risk factors for HIV-1 transmission in women: results from a cohort study. AIDS 1993; 7: 95-102.

14. Wasserheit JN. Epidemiological synergy: interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sex Transm Dis 1992; 19: 61-77.

15. Wood GL. Update on laboratory diagnosis of sexually transmitted diseases. Clin Lab Med 1995; 15: 665-85.

16. Hale YM, Melton ME, Lewis JS, Willis DE. Evaluation of the pace 2 Neisseria gonorrhoeae assay by three public health laboratories. J Clin Microbiol 1993; 31: 451-3.

17. Quan M. Pelvic inflammatory disease: diagnosis and management. J Am Board Fam Pract 1994; 7: 110-23.

18. Hillis SD. PID prevention: clinical and societal stakes. Hosp Pract 1994; 121-30.

19. Ault KA, Faro S. Pelvic inflammatory disease current diagnostic criteria and treatment guidelines. Postgrad Med 1993; 93: 85-91.

20. Hook EW, Marra CM. Acquired syphilis in adults. N Engl J Med 1992; 326: 1060-7.

21. Hook EW, Marra CM. Acquired syphilis in adults. N Engl J Med 1992; 326: 1060-9.

22. Flores JL. Syphilis a tale of twisted tremonemes. West J Med 1995; 163: 552-9.

23. Heaton CL. Clinical manifestations and modern management of condylomata accuminata: a dermatologic perspective. Am J Obstet Gynecol 1995; 172:1344-50.

24. Stone KM. Human papillomavirus infection and genital warts: update on epidemiology and treatment. Clin Infect Dis 1995; 20 Suppl 1: S91-7.

25. Mayeaux EJ, Harper MB, Barksdale W, Pope JB. Noncervical human papillomavirus genital infections. Am Fam Pract 1995; 52: 1137-46.

26. Clark JL, Tatum NO, Noble SL. Management of genital herpes. Am Fam Pract 1995; 51:175-81.

27. Koutsky LA, Stevens CE, Holmes KK, et al. Underdiagnosis of genital herpes by current clinical and viral-isolation procedures. N Engl J Med 1992; 326: 1533-9.

28. Hoffman IF, Schmitz JL. Genital ulcer disease. Postgrad Med 1995; 98: 67-82.

29. Cone RW, Swendson PD, Hobson AC. Herpes simplex virus detection from genital lesions: a comparative study using antigen detection (HerpChek) and culture. J Clin Microbiol 1993; 31: 1774-6.

30. Goens JL, Schwartz RA, De Wolf K. Mucocutaneous manifestations of chancroid, lymphogranuloma venerum and granuloma inguinale. Am Fam Pract 1994; 49: 415-25.

31. Krieger JN. Trichomoniasis in men: old issues and new data. Sex Transm Dis 1995; 22: 83-6.

32. Forsman KE. Pediculosis and scabies. Postgrad Med 1995; 98: 89-100.

33. Arlian LG, Runyan RA, Achar S, Estes SA. Survival and infec-tivity of Sarcoptes scabiei var canis var hominis. J Am Acad Dermatol 1984;11:210-15.