&lt;h2 class=&quot;first last&quot;&gt;What does research say?&lt;/h2&gt;
&lt;p class=&quot;chapter-para&quot;&gt;&lt;a href=&quot;https://academic.oup.com/cid/article/36/4/e61/442979&quot;&gt;&lt;strong&gt;&lt;em&gt;Clostridium difficile&amp;nbsp;Colitis after Forced Anal-Receptive Intercourse&lt;/em&gt;&lt;/strong&gt;&lt;/a&gt;&lt;/p&gt;
&lt;p class=&quot;chapter-para&quot;&gt;&lt;strong&gt;&lt;em&gt;Discussion&lt;/em&gt;&lt;/strong&gt;. In patients with sexually transmitted diseases (STDs), there is a high rate of colonization with&amp;nbsp;&lt;em&gt;C. difficile&lt;/em&gt;&amp;nbsp;in the male and female genital tract. At an STD clinic in Sheffield, United Kingdom, 106 women (72%) who presented at the clinic were colonized with&amp;nbsp;&lt;em&gt;C. difficile&lt;/em&gt;&amp;nbsp;in the vaginal tract, and 42 men (100%) were colonized with&amp;nbsp;&lt;em&gt;C. difficile&lt;/em&gt;&amp;nbsp;in the urethra. By contrast, only 18% of 210 women who attended a family planning clinic had vaginal colonization with&amp;nbsp;&lt;em&gt;C. difficile&lt;/em&gt;, and none of 50 men in a general urology clinic had urethral&amp;nbsp;&lt;em&gt;C. difficile&lt;/em&gt;&amp;nbsp;colonization [&lt;span id=&quot;jumplink-ref7&quot; class=&quot;xrefLink&quot;&gt;&lt;/span&gt;&lt;a data-open=&quot;ref7&quot;&gt;7&lt;/a&gt;]. At another STD clinic, 21% of women presenting for the first time had vaginally colonization with&amp;nbsp;&lt;em&gt;C. difficile&lt;/em&gt;&amp;nbsp;[&lt;span id=&quot;jumplink-ref8&quot; class=&quot;xrefLink&quot;&gt;&lt;/span&gt;&lt;a data-open=&quot;ref8&quot;&gt;8&lt;/a&gt;]. Other investigators, however, found little to no colonization in such women. The presence of&amp;nbsp;&lt;em&gt;C. difficile&lt;/em&gt;&amp;nbsp;bacteria in the genital tracts of patients with STDs suggests that the organism itself can be transmitted sexually.&lt;/p&gt;
&lt;p class=&quot;chapter-para&quot;&gt;Intestinal infections are common in homosexual men. A wide spectrum of enteric pathogens have been observed in immunocompetent individuals, as well as in HIV-infected patients [&lt;span id=&quot;jumplink-ref3&quot; class=&quot;xrefLink&quot;&gt;&lt;/span&gt;&lt;a data-open=&quot;ref3&quot;&gt;3&lt;/a&gt;,&amp;nbsp;&lt;span id=&quot;jumplink-ref9&quot; class=&quot;xrefLink&quot;&gt;&lt;/span&gt;&lt;a data-open=&quot;ref9&quot;&gt;9&lt;/a&gt;]. In a study of homosexual men who presented with diarrhea or proctitis, 64% of symptomatic patients were HIV positive, as determined using a serological assay, but their conditions did not conform to the clinical definition of AIDS. An organism was identified in 63% of cases, most commonly herpes simplex virus (in 22%),&amp;nbsp;&lt;em&gt;Campylobacter&lt;/em&gt;&amp;nbsp;species (in 19%),&amp;nbsp;&lt;em&gt;Neisseria gonorrhoeae&lt;/em&gt;&amp;nbsp;(in 13%),&amp;nbsp;&lt;em&gt;Giardia lamblia&lt;/em&gt;&amp;nbsp;(in 10%), and&amp;nbsp;&lt;em&gt;Chlamydia trachomatis&lt;/em&gt;&amp;nbsp;(in 9%).&amp;nbsp;&lt;em&gt;C. difficile&lt;/em&gt;&amp;nbsp;toxin was identified in 4.5% of cases. In the same study, a similar spectrum of enteric organisms was found in patients with AIDS who presented with diarrhea, but the incidence of&amp;nbsp;&lt;em&gt;Cryptosporidium&lt;/em&gt;&amp;nbsp;infection was much higher (16% for patients with AIDS vs. 3% for patients without AIDS).&amp;nbsp;&lt;em&gt;C. difficile&lt;/em&gt;&amp;nbsp;cytotoxin was found in 7.1% of patients with AIDS who had diarrhea [&lt;span id=&quot;jumplink-ref3&quot; class=&quot;xrefLink&quot;&gt;&lt;/span&gt;&lt;a data-open=&quot;ref3&quot;&gt;3&lt;/a&gt;].&lt;/p&gt;
&lt;p class=&quot;chapter-para&quot;&gt;Infections with&amp;nbsp;&lt;em&gt;C. difficile&lt;/em&gt;&amp;nbsp;(without cytotoxin implication) have been reported in the female genital tract.&amp;nbsp;&lt;em&gt;C. difficile&lt;/em&gt;&amp;nbsp;was isolated, usually in combination with other anaerobes, from a total of 34 women with vaginal abscess, pelvic abscess, perinatal sepsis, ovarian abscess, or endometritis or who had experienced septic abortion [&lt;span id=&quot;jumplink-ref8&quot; class=&quot;xrefLink&quot;&gt;&lt;/span&gt;&lt;a data-open=&quot;ref8&quot;&gt;8&lt;/a&gt;].&lt;/p&gt;
&lt;p class=&quot;chapter-para&quot;&gt;To our knowledge, this report represents the first case of an immunocompetent heterosexual man who developed&amp;nbsp;&lt;em&gt;C. difficile&lt;/em&gt;&amp;nbsp;colitis after forced anal-receptive intercourse. There is a considerable rate of male urethral colonization with&amp;nbsp;&lt;em&gt;C. difficile&lt;/em&gt;&amp;nbsp;in the setting of STDs. Therefore, male-to-male sexual transmission of&amp;nbsp;&lt;em&gt;C. difficile&lt;/em&gt;, possibly resulting in cytotoxin-related colitis may be more common than has previously been appreciated. For patients who present with diarrhea and abdominal symptoms after anal-receptive intercourse, clinicians should consider sexually transmitted&amp;nbsp;&lt;em&gt;C. difficile&lt;/em&gt;&amp;nbsp;colitis in the differential diagnosis.&lt;/p&gt;
&lt;p class=&quot;chapter-para&quot;&gt;&amp;nbsp;&lt;/p&gt;
&lt;p class=&quot;heading-title&quot;&gt;&lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/2831107/&quot;&gt;&lt;em&gt;&lt;strong&gt;Prevalence of enteric pathogens in homosexual men with and without acquired immunodeficiency syndrome&lt;/strong&gt;&lt;/em&gt;&lt;/a&gt;&amp;nbsp;&lt;/p&gt;
&lt;h2 class=&quot;title&quot;&gt;Abstract&lt;/h2&gt;
&lt;div id=&quot;enc-abstract&quot; class=&quot;abstract-content selected&quot;&gt;
&lt;p&gt;We studied 388 homosexual or bisexual men from the Baltimore-Washington area to define the spectrum of enteric pathogen carriage in &lt;span style=&quot;color: #cc99ff;&quot;&gt;a population at high risk for &quot;gay bowel syndrome&quot;&lt;/span&gt; in association with human immunodeficiency virus infection. Seventy-seven patients with acquired immunodeficiency syndrome, 68 gay men with symptoms of acute diarrhea or proctitis, and 243 gay men without gastrointestinal symptoms and participating in a natural history study of human immunodeficiency virus infection were selected for study. Approximately 12% of the asymptomatic men harbored at least one enteric pathogen; the most frequently recovered were Chlamydia trachomatis, herpes simplex virus, and Giardia lamblia. Men carrying a pathogen were more likely to be human immunodeficiency virus seropositive (48%) than men without a pathogen (25%) (p = 0.018), more likely to have fewer T helper cells (p = 0.015), and more likely to have a mucopurulent exudate (p = 0.014). We recovered an agent of enteric disease from 68% of gay men presenting with diarrhea or proctitis. Campylobacter species, herpes simplex virus, Neisseria gonorrhoeae, C. trachomatis, G. lamblia, and Shigella species were identified most frequently. The most common pathogen associated with diarrhea in acquired immunodeficiency syndrome was Cryptosporidium (16% of 49 cases). Other agents identified were Clostridium difficile, Vibrio parahemolyticus, Campylobacter species, G. lamblia, Isospora, and cytomegalovirus. Approximately half of the identifiable etiologic agents of diarrhea in acquired immunodeficiency syndrome patients were treatable with antibiotics, but these agents required special culture procedures for detection.&lt;/p&gt;
&lt;/div&gt;

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