- • A thorough sexual history, including information
about the practice of rectal sex (receptive or insertive) or oral-anal
sex, with or without condoms.
- • Screening for rectal pathogens based on sexual
- • Anoscopy in patients with symptoms of anorectal
pain, tenesmus, or discharge.
- • Collection of specimens for gonorrhea, chlamydia,
and serologic tests for syphilis and HIV, and stool specimens for
culture and ova and parasite examinations in patients with symptoms
Proctitis is an inflammatory condition of the rectum that usually
occurs secondary to infection introduced during sexual activity.
A more extensive condition—proctocolitis—may occur
after oral ingestion of a pathogen that produces colorectal inflammation.
Both conditions are noted more frequently in men who have sex with
men (MSM). Proctitis is commonly caused by gonorrhea, chlamydia,
and herpes simplex virus (HSV) infections, and proctocolitis by
enteric bacteria or parasites.
The incidence of acute, sexually transmitted proctitis and proctocolitis,
which decreased dramatically during the 1980s and early 1990s, began
increasing again in the mid-1990s. As a consequence of successful
antiretroviral therapy for HIV infection and AIDS, declining concern
about HIV and AIDS, and renewed physical health, many HIV-infected
men in the United States have increasingly been engaging in sexual
risk behaviors associated with the spread of STDs. Consistent condom
use between HIV-infected sex partners in some cities has also declined,
resulting in substantial increases in rates of syphilis and rectal
Sexually transmitted intestinal infections may be transmitted
by direct rectal inoculation or indirectly in the course of oral-anal
contact. Conventional sexually transmitted diseases (STDs) most often
cause rectal infections through direct inoculation by anal intercourse,
although perineal contamination by cervicovaginal secretions among
women has been described. Chlamydia trachomatis and Neisseria gonorrhoeae infect columnar
epithelium and infect the anorectal mucosa via oral-genital and
rectal insertive intercourse. HSV, human papillomavirus, and Treponema pallidum infect stratified
squamous epithelium and can be transmitted similarly to the anorectal
region. Although not considered “classical” STDs,
enteric pathogens, parasites, and hepatitis A and B can be transmitted
during direct oral-anal contact, (anilingus) or during oral-genital
contact after rectal intercourse. Exposure to as few as 10–100
organisms of Shigella, Entamoeba histolytica cysts, or Giardia lamblia cysts may precipitate
Multiple partners, anonymous partners, and individual sexual
practices that increase the risk of acquiring specific diseases
are associated with increased risk of acquiring any STD. Individuals who
engage in receptive anal intercourse or anilingus are at high risk
for acquiring sexually transmitted proctitis and enteritis.
Anal intercourse continues as a prevalent sexual practice in
both homosexual and heterosexual populations. Studies report that
up to 43% of adult women have participated in anal intercourse. Teen
definitions of sexual activity may not include oral or anal sex,
and the prevalence of anal sex among teens ...