Mpox (monkeypox) is an emerging viral infection with a broad and evolving clinical spectrum that increasingly spans beyond its characteristic cutaneous manifestations. Anorectal manifestations are well recognized in patients with Mpox in recent outbreaks. However, the gastrointestinal (GI) or anorectal symptoms may precede the typical rash, creating significant diagnostic challenges and delaying appropriate infection control measures. We describe a quinquagenarian man with poorly controlled diabetes mellitus who presented with fever, diarrhea, tenesmus, and severe perianal pain. Cross-sectional imaging demonstrated diffuse rectosigmoid inflammation, while endoscopy revealed severe ulcerative proctitis. Initial evaluation favored acute infectious proctitis, and treatment was directed accordingly. However, the subsequent development of disseminated pustular skin lesions prompted consideration of Mpox, which was ultimately confirmed by polymerase chain reaction testing of the lesions. Extensive testing excluded concurrent human immunodeficiency virus (HIV) infection and other common sexually transmitted infections, and rectal biopsy demonstrated nonspecific acute colitis. The patient recovered with supportive management and had complete endoscopic resolution on follow-up colonoscopy. This case illustrates the relevance of considering Mpox in the differential diagnosis of acute proctitis and lower GI symptoms, even before characteristic skin lesions appear. It also underscores the diagnostic value of maintaining a high index of suspicion in patients presenting with severe anorectal disease and points out that diabetes-associated immune dysfunction may play a role in such cases. Early recognition of atypical GI manifestations is essential for timely diagnosis, appropriate patient isolation, avoidance of unnecessary interventions, and optimal clinical outcomes.

[This retracts the article DOI: 10.1016/j.heliyon.2024.e31982.].

Anorectal bacterial sexually transmitted infections, predominantly chlamydia, gonorrhoea and syphilis, represent a substantial and evolving global health challenge, with incidence rising despite widespread testing availability. In this Review, we examine the epidemiology and burden of anorectal sexually transmitted infections, explore the pathogenic mechanisms underlying infection and discuss advances in diagnosis, screening and prevention strategies. Anorectal infections are frequently asymptomatic, particularly among men who have sex with men, in which they often exceed the prevalence of urogenital infections. Asymptomatic persistence results from bacterial adaptation to rectal tissues and attenuated local immune responses that fall below symptom thresholds. Molecular diagnostics have transformed detection capabilities, yet substantial challenges persist in distinguishing viable from non-viable microorganisms, expanding point-of-care testing access and balancing screening benefits against antimicrobial stewardship concerns. Treatment approaches continue to evolve in response to emerging resistance patterns, particularly for gonorrhoea. Promising prevention innovations include doxycycline post-exposure prophylaxis, which substantially reduces chlamydia and syphilis incidence and artificial intelligence applications. However, practical implementation in diverse clinical settings remains limited. We highlight important gaps in knowledge and propose research priorities to advance effective control strategies.

Lymphogranuloma venereum (LGV) caused by Chlamydia trachomatis (CT) serovars L1-L3 has re-emerged among men who have sex with men (MSM), predominantly manifesting as anorectal disease. Oropharyngeal LGV remains poorly characterized, with only sporadic case reports in Western countries. Although CT genovariant L2b has been detected in an oropharyngeal specimen through surveillance in Taiwan, the clinical features of oropharyngeal LGV have not been described in Asia. We report two MSM living with HIV in Taiwan with oropharyngeal LGV. Case 1 was a 32-year-old asymptomatic patient and CT was identified through routine multi-site screening prompted by a rising rapid plasma reagin (RPR) titer. LGV was detected only at the oropharyngeal site, with a negative rectal specimen. Case 2, a 51-year-old man, presented with small oral ulcers resembling aphthous stomatitis, along with anorectal symptoms and amoebic liver abscess. Genovariant L2b was confirmed in both oropharyngeal and rectal specimens by ompA sequencing. In both cases, Treponema pallidum PCR on oropharyngeal specimens was negative despite elevated RPR titers. Case 1 received doxycycline 100 mg twice daily for 7 days for asymptomatic LGV carriage, while Case 2 received a 21-days course for symptomatic infection. Case 1 achieved microbiological cure confirmed by follow-up PCR testing. Case 2 demonstrated resolution of oral and anorectal symptoms, with microbiological cure confirmed at follow-up. These cases illustrate that oropharyngeal LGV may be asymptomatic or mimic common oral conditions. Multi-site CT testing and ompA genotyping should be considered in MSM with suspected STI, even in the absence of typical anorectal symptoms.

We describe a rapidly expanding clade Ib mpox outbreak among gay, bisexual and other men who have sex with men in Northern Ireland. Following 12 months with no detected mpox cases, 22 confirmed cases were notified between 6 and 30 June 2026. Cases had a median age of 41 years; 19 had not travelled outside the United Kingdom or Ireland in the 21 days before symptom onset. The outbreak is characterised by severe anorectal disease and presentation to non-sexual health settings, including secondary care.

Anorectal malformations (ARM) present with a wide clinical spectrum in severity, with associated anomalies in up to 70% of cases. An increasing number of patients now reach adulthood, resulting in a shift in focus towards long-term function beyond the reconstructive period and securing transition of care. Urological morbidity is common and persists into adult life. Reported rates of urinary incontinence vary considerably depending on the severity of the malformation as well as associated sacral and spinal anomalies. Further sequelae include recurrent urinary tract infections, a retained remnant of the original fistula (ROOF), iatrogenic urogenital injury, chronic kidney disease, and impaired fertility.This narrative review proposes a risk-adapted follow-up scheme based on a structured history (voiding and bowel diaries), ultrasound, laboratory and microbiological assessment, as well as functional testing (uroflowmetry, urodynamics). These findings guide conservative treatment (urotherapy, bowel management, intermittent catheterization) and the decision for surgery. To date, no standardized follow-up recommendations exist for adult care. Risk-stratified interdisciplinary monitoring and initiation of transition at the onset of puberty are essential.

Currarino Syndrome (CS) should be suspected in infants presenting with persistent constipation and sacral anomalies. Early diagnosis using appropriate imaging and multidisciplinary surgical management is essential to prevent serious complications such as bowel obstruction, infection, and neurological impairment.

Persistent immune activation and inflammation contribute to non-AIDS comorbidities in people living with HIV (PLWH) despite long-term virological suppression. Given the central role of the gut in immune homeostasis, we investigated whether mucosal and peripheral molecular signatures relate to clinical status, immune recovery, and antiretroviral therapy (ART) class. Sixty-eight virologically suppressed PLWH were stratified by CDC clinical stage, ART regimen (integrase strand transfer inhibitor [INSTI]-based vs. non-INSTI), and CD4/CD8 ratio. Targeted gene expression was assessed by RT-PCR in anorectal mucosal biopsies and peripheral blood mononuclear cells, while epithelial protein expression was evaluated by Western blot in mucosal biopsies. Plasma biomarkers of epithelial injury, microbial translocation, and systemic inflammation were quantified by ELISA. Group comparisons and correlation analyses were performed using non-parametric statistics. Mucosal analyses revealed distinct transcriptional and protein-level alterations associated with clinical and immunological stratifications, whereas peripheral cellular and circulating biomarkers showed limited discriminatory capacity. Notably, specific ART-related patterns emerged at the mucosal level, accompanied by coordinated associations between epithelial junctional features and local immune parameters that were not mirrored systemically. Together, these findings indicate persistent, spatially restricted epithelial-immune remodelling in treated HIV infection, underscoring the importance of direct mucosal assessment to capture residual barrier and immune perturbations under suppressive ART.

Rheumatoid arthritis (RA) is a chronic inflammatory joint disease characterized by persistent synovial inflammation and progressive cartilage and bone destruction. Triptolide (TP) exhibits potent anti-inflammatory activity, but its therapeutic application is limited by poor aqueous solubility and a narrow therapeutic window. To address these limitations, we developed dissolving hyaluronic acid (HA) microneedles (MNs) incorporating a TP-loaded microemulsion (mean diameter: 27.6 ± 4.4 nm) for local transdermal delivery. The TP-loaded microneedles (TP MNs) showed a uniform pyramidal morphology (height of ∼500 μm) and adequate mechanical strength (fracture force: 0.098 ± 0.010 N per needle), supporting skin insertion with microchannel depths of approximately 450 μm. In vitro, TP MN-derived preparations reduced the viability, migration, and invasion of rheumatoid arthritis fibroblast-like synoviocytes (RA-FLS), and decreased inflammatory mediator production, including TNF-α, IL-1β, IL-6, GM-CSF, and CSF-1R. In vivo, TP MNs alleviated joint swelling, synovial hyperplasia, cartilage damage, and bone erosion in a collagen-induced arthritis (CIA) rat model relative to TP HA solution and blank MN controls. At the molecular level, TP-containing treatment was associated with changes in NF-κB-associated downstream readouts in synovial tissues and RA-FLS. Under the present dosing regimen, serum ALT, AST, BUN, and CRE remained comparable among groups, providing preliminary evidence for the absence of overt short-term hepatorenal dysfunction within the study period. Collectively, these results support microemulsion-embedded HA microneedles as a promising local TP delivery platform for inflammatory arthritis, while warranting further investigation of long-term safety, complete pharmacokinetic profiles, and application-site effects.