The Prevalence of Chlamydia Trachomatis and Neisseria Gonorrhoeae in Patients Suspected of Hemorrhagic Proctosigmoiditis
Conditions: Proctitis, Ulcerative, Sexually Transmitted Disease (STD), Ulcerative Proctosigmoiditis
Sponsor: University of Aarhus

Cover page 
 
The prevalence of Chlamydia trachomatis and Neisseria 
gonorrhoeae in patients suspected of hemorrhagic 
proctosigmoiditis (SOS Proctitis) 
 
A quality improvement project in the Central Denmark 
Region 
 
 
Initial internal protocol 
 
Version 1., October 1st, 2024 
 
 
 
 
 
 
 
 

Quality Assurance Project: Infectious 
Proctitis, Aarhus University Hospital 
Updated on 01.10.2024 
Application: Approval of quality assurance project and permission to access patient records and 
other electronic patient systems without patient consent. 
 
Project Title: 
Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in Patients Suspected of 
Hemorrhagic Proctosigmoiditis 
 
Background and Purpose: 
It is known that Chlamydia trachomatis and Neisseria gonorrhoeae can cause infectious proctitis 
that is macroscopically indistinguishable from hemorrhagic proctosigmoiditis (HP), which is 
associated with the chronic inflammatory bowel disease ulcerative colitis. 
Currently, it is not standard practice to inquire about sexual risk behaviour or test for Chlamydia 
trachomatis and Neisseria gonorrhoeae during the initial diagnostic workup of proctitis. This is 
despite the fact that these pathogens represent the most frequent causes of symptomatic sexually 
transmitted proctitis, with an increasing incidence in Denmark. Their inclusion in the standard 
diagnostic evaluation for proctitis therefore seems warranted. 
As a result, we lack epidemiological insight into how many patients diagnosed with HP may, in 
fact, have infectious proctitis caused by a sexually transmitted infection with Chlamydia 
trachomatis and/or Neisseria gonorrhoeae. 
We aim to determine the proportion of patients with either newly diagnosed or treatment-refractory 
HP who have an underlying infection with Chlamydia trachomatis and/or Neisseria gonorrhoeae. 
The objective is to evaluate whether routine screening for these pathogens should be implemented 
in the diagnostic workup of proctitis. 
 
Materials: 
All patients suspected of proctitis undergo endoscopy (either sigmoidoscopy or colonoscopy) to 
establish the diagnosis. In cases of inflammation up to 35 cm from the anal verge, an additional 

swab for Chlamydia and Gonorrhoea will be collected during the examination. If this is not 
performed at the time of endoscopy, it will be conducted at a follow-up outpatient visit. 
Patients who do not respond to standard therapy and continue to have disease limited to the 
proximal 35 cm will undergo re-testing. 
 
Method: 
Over a 24-month period, we will include all patients at Aarhus University Hospital diagnosed with 
proctosigmoiditis (i.e. endoscopic inflammation from the anal verge to 35 cm proximally) or with 
treatment-refractory disease (defined by escalation to biological therapy). 
Staff responsible for microbiological test ordering for Chlamydia and Gonorrhoea will assign Dr. 
David Haldrup, Department of Hepatology and Gastroenterology, as the responsible physician in 
the EPJ system for test follow-up. 
All patients with microbiological test orders under Dr. Haldrup’s name will be recorded in the 
Region Midt REDCap database. These patients will follow standard clinical pathways in the 
Department of Hepatology and Gastroenterology at Aarhus University Hospital. Patients testing 
positive for Chlamydia or Gonorrhoea will be offered treatment through the Department of 
Dermatology and Venereology, where the responsible consultant is Dr. Line Kibsgaard. 
The included patients will constitute a prospective cohort. Their disease course will be documented 
with respect to the extent of hemorrhagic proctitis and current pharmacological treatment. 
 
Reporting: 
Data will be processed by: 
• 
David Haldrup 
• 
Ditte Smed Kornum 
• 
Line Kibsgaard 
• 
Christian Lodberg Hvas 
• 
Anders Kirch Dige 
Results will be incorporated into a manuscript for publication, regardless of outcome. If Chlamydia 
and Gonorrhoea are found to be prevalent, routine screening will be implemented for all patients 
referred for proctitis evaluation and for those with treatment-refractory disease. 
If patients improve following pathogen-directed treatment and avoid treatment-refractory disease, 
the project may yield cost savings in terms of reduced use of biological agents.