Answers are grounded in this paper and cite their sources.
Systematic review uncovers frequent misdiagnosis and high co-infection rates in MSM with anorectal syphilis, highlighting the need for refined clinical guidelines.
Objective The aim of this systematic review was to explore the characteristics of men who have sex with men (MSM) with anorectal Treponema pallidum (syphilis). Method Four bibliographical databases (Medline, Embase, CINAHL, Web of Science) were searched in September 2025 for publications written in English exploring at least one characteristic in MSM with symptomatic anorectal syphilis. Two authors independently reviewed full-text publications, assessed the risk of bias (Joanna Briggs Institute toolkit) and performed a narrative synthesis to generate thematic data. Results 37 manuscripts were included in this analysis published between 1966 and 2025 from Europe (n=13), Asia (n=11), the USA (n=11), Israel (n=1) and Peru (n=1) and were case reports (n=29) and case series (n=8) that included 67 MSM. This review highlighted demographic (living with HIV, being a sex worker, living with a vulnerability (intellectual disability, being a victim of sexual violence/exploitation, being a migrant)), behavioural (condomless receptive anal sex, oral-anal sex (rimming), having multiple non-regular sexual partners, travel and sex), co-infection (new HIV diagnosis, Neisseria gonorrhoeae, Chlamydia trachomatis including lymphogranuloma venereum, herpes simplex virus, human papillomavirus, acute hepatitis B, Entamoeba histolytica ), symptom (rectal pain, rectal bleeding, tenesmus, anorectal ulcers, change in bowel habit, ulcerated/mass lesion, fever) and clinical (erroneously investigated, hospitalised, diagnosed and treated for other anal-rectal conditions (neoplasia, inflammatory bowel disease), having a syphilis rash, transaminitis and the Jarisch-Herxheimer reaction) characteristics seen in MSM with anorectal syphilis. Conclusion This review provides important demographic, co-infection, behavioural and clinical pathway data to inform future clinical guidelines, public health strategies and research in anorectal syphilis in MSM. PROSPERO registration number CRD420251107692.
No takes yet. Share an insight, caveat, or question.
Caid et al. (2026) studied this question.
Synapse has enriched 10 related papers. Consider them for comparative context: