{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:10:05Z","timestamp":1756314605834,"version":"3.44.0"},"reference-count":10,"publisher":"BMJ","issue":"1","funder":[{"DOI":"10.13039\/100010585","name":"University of Miami Libraries","doi-asserted-by":"publisher","award":["SF0044771"],"award-info":[{"award-number":["SF0044771"]}],"id":[{"id":"10.13039\/100010585","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,12,1]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>Sexually transmitted proctitis, a prevalent concern among men who have sex with men (MSM) is frequently caused by a range of pathogens, including herpes simplex virus (HSV), <jats:italic>Neisseria gonorrhoeae<\/jats:italic> and <jats:italic>Chlamydia trachomatis<\/jats:italic>. While HSV-associated proctitis typically presents with visible lesions, cases without external manifestations remain evasive. We report the case of an MSM in his early 30s presenting with dyschezia and perineal discomfort after unprotected anoreceptive intercourse. Despite initial inconspicuous findings, rectal swabs revealed HSV-2 infection. Subsequent escalation to purulent discharge prompted further investigation, revealing mucosal thickening on imaging consistent with proctitis. Remarkably, the patient later exhibited symptoms suggestive of aseptic meningitis, with cerebrospinal fluid (CSF) analysis confirming HSV-2 DNA. This atypical progression underscores the covert threat posed by HSV-2 proctitis, potentially culminating in neurological complications. Our case highlights the imperative for heightened vigilance and comprehensive testing in MSM engaging in receptive anal intercourse, advocating for early detection and intervention to prevent grave sequelae.<\/jats:p>","DOI":"10.1136\/bcr-2024-261406","type":"journal-article","created":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T09:01:08Z","timestamp":1736326868000},"page":"e261406","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Aseptic meningitis from herpes simplex virus proctitis"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9178-9913","authenticated-orcid":false,"given":"Bardia","family":"Adibmoradi","sequence":"first","affiliation":[{"name":"Graduate Medical Education, University of Miami Miller School of Medicine, Fort lauderdale, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis","family":"Penaranda,","sequence":"additional","affiliation":[{"name":"Graduate Medical Education, University of Miami Miller School of Medicine, Fort lauderdale, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathalie","family":"Wacher","sequence":"additional","affiliation":[{"name":"Graduate Medical Education, University of Miami Miller School of Medicine, Fort lauderdale, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anita","family":"Sikha","sequence":"additional","affiliation":[{"name":"Graduate Medical Education, University of Miami Miller School of Medicine, Fort lauderdale, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,1,8]]},"reference":[{"key":"2025082709563502000_18.1.e261406.1","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1007\/DCR.0b013e31819ad537","article-title":"Sexually Transmitted Infections as a Cause of Proctitis in Men Who Have Sex with Men","volume":"52","author":"Davis","year":"2009","journal-title":"Dis Colon Rectum"},{"key":"2025082709563502000_18.1.e261406.2","doi-asserted-by":"publisher","DOI":"10.1136\/pmj.2006.048488"},{"key":"2025082709563502000_18.1.e261406.3","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-39-4-675"},{"key":"2025082709563502000_18.1.e261406.4","first-page":"137","volume-title":"Nonclassical Pathogens as Causative Agents of Proctitis in Men Who Have Sex with Men","volume":"19","author":"Chow","year":"2021"},{"key":"2025082709563502000_18.1.e261406.5","doi-asserted-by":"publisher","DOI":"10.1136\/sti.58.1.52"},{"key":"2025082709563502000_18.1.e261406.6","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2020-237247","article-title":"HSV-associated proctitis presenting without perianal lesions: why testing and empirical treatment may be important","volume":"14","author":"Hughes","year":"2021","journal-title":"BMJ Case Rep"},{"key":"2025082709563502000_18.1.e261406.7","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu772"},{"key":"2025082709563502000_18.1.e261406.8","unstructured":"Melia M . Johns Hopkins ABX Guide. The Johns Hopkins University; Aseptic Meningitis, 2022. Available: https:\/\/www.hopkinsguides.com\/hopkins\/view\/Johns_Hopkins_ABX_Guide\/540035\/all\/Aseptic_Meningitis"},{"key":"2025082709563502000_18.1.e261406.9","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofac644","article-title":"Treatment of Herpes Simplex Virus Type 2 Meningitis: A Survey Among Infectious Diseases Specialists in France, Sweden, Australia, and Denmark","volume":"9","author":"Bodilsen","year":"2022","journal-title":"Open Forum Infect Dis"},{"key":"2025082709563502000_18.1.e261406.10","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1093\/cid\/ciab1071","article-title":"Herpes Simplex Virus 2 Meningitis in Adults: A Prospective, Nationwide, Population-Based Cohort Study","volume":"75","author":"Jakobsen","year":"2022","journal-title":"Clin Infect Dis"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-261406","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:56:44Z","timestamp":1756313804000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-261406"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":10,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,8]]},"published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1136\/bcr-2024-261406"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-261406","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2025,1]]}}}