Diagnosis and Treatment of Sexually Acquired Proctitis and Proctocolitis: An Update

Abstract

Sexually transmitted gastrointestinal syndromes include proctitis, proctocolitis, and enteritis. These syndromes can be caused by one or multiple pathogens. Routes of sexual transmission and acquisition include unprotected anal intercourse and oral-fecal contact. Evaluation should include appropriate diagnostic procedures such as anoscopy or sigmoidoscopy, stool examination, and culture. When laboratory diagnostic capabilities are suff cient, treatment should be based on specif c diagnosis. Empirical therapy for acute proctitis in persons who have recently practiced receptive anal intercourse should be chosen to treat Neisseria gonorrhoeae and Chlamydia trachomatis infections. In individuals infected with human immunodef ciency virus (HIV), other infections that are not usually sexually acquired may occur, and recurrent herpes simplex virus infections are common. The approach to gastrointestinal syndromes among HIV-infected patients, therefore, can be more comprehensive and will not be discussed in this article.Brief Review: Acute Proctitis/Proctocolitis frequently involve direct or indirect contact of the rectal mucosal membranes [11 -13]. Specific pathogens most commonly The incidence of acute, sexually transmitted proctitis and infect specific sites and have different modes of transmission. proctocolitis has appeared to decrease over the past decade.Fecal-oral passage of enteric pathogens, parasites, and hepatitis With the emergence of AIDS and identification of HIV, unpro-A and B viruses occurs predominantly during direct oral-anal tected anal intercourse was reported to be the most efficient contact, or analingus, or during oral-genital contact after rectal mode of sexual transmission of HIV infection [1,2]. Advocates intercourse [14]. Exposure to as few as 10 -100 organisms may of ''safer'' sexual practices, therefore, admonish unprotected precipitate infection. Chlamydia trachomatis and Neisseria gosexual contact of any kind, especially rectal intercourse.norrhoeae infect columnar epithelium and infect the anorectal Since the national rates of rectal gonococcal infections demucosa via oral-genital and rectal insertive intercourse. Herpes creased dramatically, particularly among homosexual men, simplex virus (HSV), human papilloma virus, and Treponema from 1985 to 1995, it has been assumed that safer-sex guidepallidum infect stratified squamous epithelium and can be lines are being followed and that the practice of anal intercourse transmitted similarly to the anorectal region. has declined [3 -5]. Data from cohort studies of homosexual Risk factors. Factors associated with an increased risk of men verify this assumption, but other recent reports of sexual acquiring any STD include multiple partners, anonymous partbehavior among homosexual and heterosexual adolescents, ilners, and individual sexual practices that increase the risk of licit drug users, and heterosexual adults suggest that unproacquiring specific diseases, as previously mentioned [15,16]. tected anal intercourse is quite common [6 -10]. Why,...

Bacterial hemorrhagic enterocolitis

“…NonLGA strains or serovars can cause mild proctitis, whereas rectal inoculation with LGA strains may cause more severe forms of ulcerative proctocolitis. 58 This infection mimics Crohn's disease because of the occurrence of chronic diarrhea and perianal fistula formation. C. trachomatis infection is determined by culturing stool or rectal swabs plated onto McCoy cells.…”

“…Colonoscopy can yield normal findings or reveal mild inflammatory changes with mucosal friability, small erosions, and follicles in the lower 10-15 cm of the rectum. 58 Histopathological examination of rectal biopsy specimens shows distinctive features consisting of granulomatous inflammation, inflammatory cell infiltrates (neutrophils and eosinophils), and crypt abscesses.…”

A Brief Review of Viral and Bacterial Sexually Transmitted Diseases in Colorectal Practice

“…Untreated chancres typically heal after several weeks. Other clinical manifestations of primary syphilis can include proctitis (with tenesmus, rectal discharge and bleeding) (9).…”

Sexually Transmitted Diseases Treatment Guidelines 2002

“…Acute proctitis of recent onset among persons who have recently practiced receptive anal intercourse is usually sexually acquired (845,846 Bloody discharge, perianal ulcers, or mucosal ulcers among MSM with acute proctitis and either a positive rectal chlamydia NAAT or HIV infection should be offered presumptive treatment for LGV with doxycycline 100 mg twice daily orally for a total of 3 weeks (847,848) (see LGV). If painful perianal ulcers are present or mucosal ulcers are detected on anoscopy, presumptive therapy should also include a regimen for genital herpes (see Genital HSV Infections).…”