Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 15-41: Anorectal Infections + Key Features Download Section PDF Listen +++ ++ Proctitis Most cases are sexually transmitted, especially by anal-receptive intercourse Causes include Neisseria gonorrhoeae Treponema pallidum (syphilis) Chlamydia trachomatis, herpes simplex virus type 2 (HSV-2) Human papillomavirus (HPV) Venereal warts (condylomata acuminata) Caused by HPV Occur in up to 25% of men who have sex with men Proctocolitis Inflammation that extends above the rectum to the sigmoid colon or more proximally Causes include Campylobacter Entamoeba histolytica Shigella Enteroinvasive Escherichia coli + Clinical Findings Download Section PDF Listen +++ ++ Proctitis Anorectal discomfort Tenesmus Constipation Discharge Gonorrhea proctitis Itching Burning Tenesmus Mucopurulent discharge Complications of untreated gonorrheal infections Strictures Fissures Fistulas Perirectal abscesses Anal syphilis Asymptomatic Chancre Proctitis In primary syphilis, chancre may mimic a fissure, fistula, or ulcer; proctitis or inguinal lymphadenopathy may be present In secondary syphilis, condylomata lata may be seen, with foul-smelling mucus discharge C trachomatis causes proctitis similar to gonorrhea or lymphogranuloma venereum, proctocolitis with fever and bloody diarrhea, painful perianal ulcerations, anorectal strictures and fistulas, and inguinal adenopathy (buboes) HSV-2 proctitis Severe pain, itching, constipation, tenesmus, urinary retention, and radicular pain Small vesicles or ulcers in the perianal area or anal canal Venereal warts are noted on examination of the perianal skin and within the anal canal; otherwise asymptomatic Higher rate of HPV progression to high-grade dysplasia or anal cancer in HIV-positive persons + Diagnosis Download Section PDF Listen +++ ++ Gonorrhea proctitis Rectal swab specimens should be taken during anoscopy for culture Gram staining is unreliable Cultures should also be taken from the urethra and pharynx in men and from the cervix in women Anal syphilis Dark-field microscopy or fluorescent antibody testing of scrapings from the chancre or condylomata Serum VDRL positive in 75% of primary and 99% of secondary syphilis Diagnosis of chlamydial infection is established by serology, culture, or PCR-based testing of rectal discharge or rectal biopsy HSV-2 Sigmoidoscopy shows vesicular or ulcerative lesions in the distal rectum Diagnosis by viral culture, polymerase chain reaction, or antigen detection assays of vesicular fluid + Treatment Download Section PDF Listen +++ ++ See treatment of specific infections Examine and treat patient's sexual partners Surveillance anoscopy every 3–6 months in HIV-positive persons