Sexually transmitted causes of urethritis, proctitis, pharyngitis, vaginitis, cervicitis and enteric infections

Sexually transmitted infections (STIs) can cause urethritis, proctitis, pharyngitis, vaginitis and/or cervicitis depending on the site of infection, although asymptomatic infections are the norm, particularly at extragenital sites. Classical STIs such as gonorrhoea and chlamydia are well-recognized causes, but many others, such as trichomoniasis, lymphogranuloma venereum, syphilis, Mycoplasma genitalium, herpes simplex and mpox can affect mucosal sites and cause inflammatory symptoms and signs. In addition, sexually transmitted enteric infections can cause symptomatic proctitis, proctocolitis, enteritis and hepatitis. In the UK there is a higher burden of STIs among those living in the most deprived regions, as well as among specific populations, including young people, gay, bisexual and other men who have sex with men and individuals from racially minoritized communities. Symptoms are often similar regardless of the underlying aetiology, and non-infectious inflammatory conditions also occur. A structured history, appropriate examination and targeted investigations are necessary to make a specific STI diagnosis. Management is best guided by the organisms detected, but treatment is often given syndromically to cover common causative organisms before results are available. Novel rapid molecular tests have the potential to improve antimicrobial stewardship in this setting. Partner notification is an integral component of STI care.