P064 Receptive anal intercourse in patients with inflammatory bowel disease: The role of sexually transmitted infections

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BACKGROUND: Receptive anal intercourse (RAI) is a common practice in both men who have sex with men (MSM) and heterosexual populations. While inflammatory bowel disease (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), affects over 1 million people in the United States, there have been no studies linking IBD and sexually transmitted infections (STIs). IBD can lead to an inflamed and leaky colonic epithelial barrier, which may increase the risk of rectal STI acquisition. The increased risk of HIV seroconversion in MSM with untreated rectal gonorrhea (GC) and chlamydia (CT) may support this theory. CASES: Our first case is of a 24-year-old MSM who was diagnosed with left-sided UC at age 21 in the setting of bloody diarrhea and tenesmus. He was originally treated with topical and oral 5-ASA, and topical steroids, but developed a mesalamine-associated rash and consequently discontinued these agents. At 24, the patient presented to clinic with recurrence of bloody diarrhea and tenesmus, and on questioning was found to engage in RAI. Rectal swab and enteric pathogen PCR panel revealed rectal gonorrhea and shigella. The patient was treated with ceftriaxone and azithromycin and symptoms completely resolved. Our second patient is a 23-year-old MSM male with UC from rectum to 50 cm who had achieved deep remission on adalimumab monotherapy, and presented with tenesmus, increased mucous, and a history of RAI. The patient tested positive for rectal CT and was treated with doxycycline. The patient’s symptoms resolved completely after treatment. DISCUSSION: Rectal STIs may complicate IBD. Underlying IBD, especially the presence of active proctitis and the utilization of immunosuppression, may increase susceptibility to STI acquisition via RAI. These cases indicate the importance of careful history taking and frequent rectal STI testing in IBD patients who engage in RAI. Future studies are required to continue to explore the influence of STIs on IBD patients who engage in RAI, including qualitative data on how IBD patients navigate RAI and STIs and quantitative data to gauge how prevalent STIs are in IBD patients compare to the general population.