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For further information, see CMDT Part 15-41: Anorectal Infections
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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
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See treatment of specific infections
Examine and treat patient's sexual partners
Surveillance anoscopy every 3–6 months in HIV-positive persons