Cause Of Proctitis Research Articles

Chlamydial Proctitis Mimicking Inflammatory Bowel Disease in a Young Active Duty Sailor With Undiagnosed Human Immunodeficiency Virus Infection: A Case Report.

Proctitis is an inflammation of the lining of the rectum that can be either acute or chronic in presentation. Symptoms include rectal bleeding, constipation, rectal discharge, rectal pain, and tenesmus. It is commonly associated with inflammatory bowel diseases (IBDs) such as ulcerative colitis and Crohn's disease. However, it is important to consider the infectious causes of proctitis such as the sexually transmitted infections (STIs), especially Chlamydia trachomatis and Neisseria gonorrhoeae, as these can mimic the symptoms and pathology of IBD. We present the case of a young male sailor with subacute rectal bleeding who was hospitalized with initial concern for an index presentation of IBD. Endoscopic evaluation revealed proctitis although findings were atypical for inflammation related to IBD. Acquisition of additional history revealed that he had both receptive and insertive anal intercourse with both male and female partners. A full STI screening, including HIV was performed. Results were positive for both rectal C. trachomatis and HIV antigen and antibody serology, which were confirmed as HIV-1 on confirmatory testing. He was treated with doxycycline for his chlamydial proctitis with symptom resolution and was also initiated on antiretroviral therapy for his HIV infection. This case highlights the importance of obtaining a sexual history and considering STIs as a cause of proctitis, as this will ensure proper screenings and prompt subsequent treatment and potentially avoid unnecessary endoscopic and medical evaluation, which could potentially worsen the underlying process.

Mpox: What Practicing Gastroenterologists Need to Know

Mpox: What Practicing Gastroenterologists Need to Know

2021 European Guideline on the management of proctitis, proctocolitis and enteritis caused by sexually transmissible pathogens.

This guideline intents to offer guidance on the diagnosis and management of patients with gastrointestinal symptoms and a suspected sexually transmitted cause. Proctitis is defined as an inflammatory syndrome of the anal canal and/or the rectum. Infectious proctitis can be sexually transmitted via genital-anal mucosal contact, but some also via digital contact and toys. Neisseria gonorrhoeae, Chlamydia trachomatis (including lymphogranuloma venereum), Treponema pallidum and herpes simplex virus are the most common sexually transmitted anorectal pathogens. Shigellosis can be transferred via oral-anal contact and may lead to proctocolitis or enteritis. Although most studies on these infections have concentrated on men who have sex with men (MSM), women having anal intercourse may also be at risk. A presumptive clinical diagnosis of proctitis can be made when there are symptoms and signs, and a definitive diagnosis when the results of laboratory tests are available. The symptoms of proctitis include anorectal itching, pain, tenesmus, bleeding, constipation and discharge in and around the anal canal. The majority of rectal chlamydia and gonococcal infections are asymptomatic and can only be detected by laboratory tests. Therefore, especially when there is a history of receptive anal contact, exclusion of anorectal infections is generally indicated as part of standard screening for sexually transmitted infections (STIs). Condom use does not guarantee protection from STIs, which are often spread without penile penetration. New in this updated guideline is: (i) lymphogranuloma venereum proctitis is increasingly found in HIV-negative MSM, (ii) anorectal Mycoplasma genitalium infection should be considered in patients with symptomatic proctitis after exclusion of other common causations such N.gonorrhoeae, C.trachomatis, syphilis and herpes, (iii) intestinal spirochetosis incidentally found in colonic biopsies should not be confused with syphilis, and (iv) traumatic causes of proctitis should be considered in sexually active patients.

Nonclassical Pathogens as Causative Agents of Proctitis in Men who Have Sex With Men.

BackgroundThis study aimed to identify enteric and sexually acquired rectal pathogens, other than chlamydia and gonorrhea, associated with symptomatic proctitis in men who have sex with men (MSM).MethodsAnorectal swab samples were obtained from MSM presenting with rectal symptoms and a clinical diagnosis of proctitis at the Melbourne Sexual Health Centre between January 2017 and March 2019. Samples that tested positive for Neisseria gonorrhoeae and Chlamydia trachomatis were excluded. As a comparison group, anorectal samples were also obtained from MSM not reporting symptoms of proctitis between November 2018 and February 2019. Samples from both groups were tested for 15 viral, bacterial, and protozoal enteric pathogens using polymerase chain reaction.ResultsAnorectal samples from 499 men with symptomatic proctitis and 506 asymptomatic men were analyzed. Age, HIV status, and pre-exposure prophylaxis (PrEP) use did not differ between men with proctitis and asymptomatic men. Treponema pallidum was more common in men with proctitis (risk difference [RD], 3.6%; 95% CI, 2.0%–5.2%). Most men with anorectal T. pallidum presented with painful anal primary infections. Shigella spp. was more common among men with proctitis compared with asymptomatic men (RD, 1.8%; 95% CI, 0.1%–3.5%). Most men with Shigella did not report diarrhea. Mycoplasma genitalium was more common in men with proctitis (RD, 4.3%; 95% CI, 1.1%–7.5%). Herpes simplex virus (HSV)–1 (RD, 10.1%; 95% CI, 6.8%–13.3%) and HSV-2 (RD, 7.2%; 95% CI, 4.5%–10.0%) were more common with proctitis.ConclusionsTesting for T. pallidum, Shigella, and HSV should be considered in MSM presenting with symptomatic proctitis. These data provide support for M. genitalium as a significant cause of proctitis. A comprehensive diagnostic evaluation is required for MSM with proctitis.

Herpes Simplex Virus Proctitis Masquerading as Rectal Cancer.

Herpes simplex virus (HSV) is the leading cause of proctitis in HIV-infected individuals. However, no cases of rectal masses secondary to HSV infection have been reported to date. Herein, we present the case of a 45-year-old man with HIV infection who developed rectal pain and bleeding, along with dysuria and voiding difficulty. Colonoscopy revealed proctitis and a rectal mass with features concerning for rectal cancer. Histologic sections of the rectal mass biopsy demonstrated colorectal mucosa with viral cytopathic changes, ulceration, granulation tissue, marked inflammatory infiltrate, and fibrinopurulent exudate. Immunohistochemistry for herpes simplex virus-1 was positive in epithelial cells demonstrating a viral cytopathic effect. The patient was treated with valacyclovir for 3 weeks, which led to complete resolution of his symptoms. Follow-up sigmoidoscopy at 6 months did not show any masses. Our case illustrates the importance of considering HSV in the differential diagnosis of rectal masses. We advocate the routine use of viral immunohistochemistry for the evaluation of rectal tumors, especially in patients with clinical manifestations and endoscopic findings consistent with proctitis.

Are patients in the IBD clinic at risk of proctitis secondary to sexually transmitted infections?

ObjectiveTo gauge the potential risk of sexually transmitted infection (STI) as a cause of proctitis in a cohort of patients with inflammatory bowel disease (IBD) and to gauge whether this...

Painful Hematochezia in HIV-Positive Male

A 37 year old male presented to the emergency room with complaints of sudden onset, progressively worsening painful hematochezia and abdominal cramping for 1 week. The patient had formed stool coated on the outside with fresh blood and clots. He denied similar symptoms in the past, local trauma, fever or diarrhea. His only medication was efavirenz/emtricitabine/tenofovir combination (Atripla) which he started taking for human immunodeficiency virus (HIV) infection in 2007. His CD4 count was 1069/mm3 and he had recently been treated for syphilis. His physical exam was unremarkable except for streaks of fresh blood and pain on rectal examination. His lab parameters were normal. A contrast enhanced CT scan showed mild rectal wall thickening possibly from proctitis or underdistension. Stool cultures were negative for ova and parasites. Urine and culture examinations were negative for Neisseria gonococcus and Chlamydia trachomatis. A flexible sigmoidoscopy showed noncircumferential diffusely erythematous mucosa with bleeding on contact, extending contiguously from 5 cm to 20 cm from the anal verge (Figure 1). Biopsies showed non-specific chronic inflammation in the lamina propria. When questioned, the patient disclosed that he recently had anal receptive intercourse. A rectal swab tested positive for Chlamydia trachomatis Lymphogranuloma venereum (LGV). He was treated with Doxycycline 100 mg BID for 21 days with resolution of symptoms. C. trachomatis is the most commonly reported sexually transmitted infection in the United States and an important cause of proctitis and proctocolitis in men who have sex with men. LGV serovars L1, L2, L3 produce a more aggressive infection manifest by perianal, anal or rectal ulceration with resulting pain and discharge. Since itis an obligate intracellular organism, diagnostic samples should contain cellular material to permit detection. This often necessitates the use of a rectal swab and subsequent microbiological assessment.Figure 1Figure 2

P013 When is a hernia not a hernia and lymphoma not lymphoma?

Background/introduction Lymphogranuloma vereneum (LGV) is a relatively common cause of proctitis and other gastrointestinal symptoms in men who have sex with men (MSM). Other symptoms and signs may present and unless a careful sexual history is taken STI may not be considered in the differential diagnosis. Aim(s)/objectives To illustrate the potential for mis/inaccurate diagnosis of groin swellings in sexually active MSM and provide a case that can be used for teaching primary care, surgical, oncology and histopathology colleagues. Methods We present a case of a 55 year old HIV-infected MSM who presented to surgical colleagues with left groin swelling. Results The patient underwent open surgery to repair an inguinal hernia. At surgery he was found to have significant inguinal lymphadenopathy. Histopathological analysis at the regional pathology centre identified a B cell lymphoma and referral was made to a haematologist to start anti-cancer therapy. In the interim the patient attended our GUM service, was diagnosed with rectal LGV and treated with antibiotics. His lymphadenopathy resolved and staging CT was negative. Discussion/conclusion Careful consideration of the differential diagnosis of inguinal swelling should be undertaken and STI excluded prior to general anaesthesia and operative procedures whenever possible. Had this patient not attended his GUM clinic he may have undergone potentially toxic chemotherapy to treat LGV infection. This case serves to illustrate the need for open communication between GUM and other medical colleagues.

Lymphogranuloma Venereum 2015: Clinical Presentation, Diagnosis, and Treatment.

Lymphogranuloma venereum (LGV) has emerged as an important cause of proctitis and proctocolitis in men who have sex with men; classical inguinal presentation is now increasingly uncommon. We report summary findings of an extensive literature review on LGV clinical presentation, diagnosis, and treatment that form the evidence base for the 2015 Centers for Disease Control and Prevention treatment guidelines for sexually transmitted diseases. Proctitis and proctocolitis are now the most commonly reported clinical manifestations of LGV, with symptoms resembling those of inflammatory bowel disease. Newer molecular tests to confirm LGV infection are sensitive and specific, but are generally restricted to research laboratory or public health settings. Doxycycline (100 mg twice daily for 21 days) remains the treatment of choice for LGV. Patients with rectal chlamydial infection and signs or symptoms of proctitis should be tested for LGV, or if confirmatory testing is not available, should be treated empirically with a recommended regimen to cover LGV infection.

Lymphogranuloma venereum detected from the pharynx in four London men who have sex with men

Lymphogranuloma venereum (LGV) is an established cause of proctitis in men who have sex with men (MSM). Currently in the UK, testing for pharyngeal Chlamydia trachomatis (CT) is not routine, and LGV typing is usually only performed in patients with anorectal symptoms. We report four cases where LGV-associated CT DNA was detected from the pharynx in MSM, demonstrating that nucleic acid amplification testing (NAAT) can be used for detecting and typing pharyngeal CT infection. These cases also highlight other possible routes of infection for LGV, and add to the broad spectrum of clinical presentations associated with this infection.

An Unusual Rectal Mass

Question: A 54-year-old man presented with a 4-day history of severe anal pain. Relevant medical history included an appendectomy, correction of an umbilical hernia, and an idiopathic proctitis in 2009 that responded to treatment with mesalazine enemas. Initially, the anal pain was related to bowel movements, but later it was continuously present especially when seated. Bowel habits had altered and the patient complained about constipation; there was no rectal blood loss or fever. The patient had a homosexual relationship and denied unsafe sexual intercourse during the past year. He tested negative for HIV. Rectal examination was painful and revealed a palpable anal and distal rectal mass. In addition, inguinal lymphadenopathy was noted. Laboratory tests showed a normal leukocyte count but an elevated C-reactive protein level (52 mg/L). Colonoscopy under sedation revealed a circular rectal mass with superficial ulceration and pus (Figure A; endoscopic retrograde view). In addition, aphthoid erosions were noted in the transverse and descending colon. Because there was a high suspicion of malignancy, a workup for rectal cancer was initiated, which included magnetic resonance imaging (MRI) showing the rectal mass with infiltration in the surrounding fat tissue (Figure B, T2 weighted, arrowhead) and locoregional (Figure C, T1 weighted, arrowhead) and inguinal (Figure B, C, arrows) lymphadenopathy. Histologic examination of the biopsies from the rectal mass showed diffuse infiltration of the lamina propria by plasma cells, lymphocytes, and occasional multinucleated giant cells. The surface epithelium was eroded and there was ulceration and focal cryptitis with infiltration of neutrophils, but no malignancy (Figure D). Additional deep incisional biopsies did also not show malignancy. What is the diagnosis of this distal rectal mass causing the severe anal pain? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. At the time the incisional biopsies were taken, serologic tests for Treponema pallidum were positive. In addition, immunohistochemical staining for spirochetes showed numerous spirochetes in the rectal biopsies (Figure E). Biopsies taken in 2009 during the episode of proctitis were immunostained and showed spirochetes in retrospect. The diagnosis was therefore late syphilis (latens tarda) presenting with severe anal pain and a rectal mass mimicking rectal cancer. After treatment with 3 injections with benzylpenicillin on days 1, 8, and 15 (after excluding neurosyphilis), the pain and serologic tests normalized completely. Within 3 months the rectal mass had disappeared, as shown by rectal examination and MRI. The patient's partner tested negative for syphilis serology. Sexually transmitted diseases (STDs) are found in 55%–86% of men who have sex with men (MSM) presenting with proctitis, with gonorrhea and chlamydia infection being the most common causes, followed by herpes and syphilis.1Klausner J.D. Kohn R. Kent C. Etiology of clinical proctitis among men who have sex with men.Clin Infect Dis. 2004; 38: 300-302Crossref PubMed Scopus (85) Google Scholar, 2Davis T.W. Goldstone S.E. Sexually transmitted infections as a cause of proctitis in men who have sex with men.Dis Colon Rectum. 2009; 52: 507-512Crossref PubMed Scopus (33) Google Scholar Rectal syphilis has many different presentations, varying from asymptomatic infection to proctitis and rarely presents as an ulcerating rectosigmoidal mass that can mimic anorectal cancer.3McMillan A. Lee F.D. Sigmoidoscopic and microscopic appearance of the rectal mucosa in homosexual men.Gut. 1981; 22: 1035-1041Crossref PubMed Scopus (71) Google Scholar Other micro-organisms that can cause a rectal mass include serovars of Chlamydia trachomatis (lymphogranuloma venerum), Mycobacterium tuberculosis, Actinomyces, and cytomegalovirus. This case illustrates the importance of taking a complete clinical history, including sexual preferences, in patients presenting with proctitis. STD as the cause of proctitis is a frequently missed diagnosis, resulting in delayed treatment and potential disease transmission. Serologic testing is therefore imperative to exclude STDs in MSM with proctitis.1Klausner J.D. Kohn R. Kent C. Etiology of clinical proctitis among men who have sex with men.Clin Infect Dis. 2004; 38: 300-302Crossref PubMed Scopus (85) Google Scholar, 2Davis T.W. Goldstone S.E. Sexually transmitted infections as a cause of proctitis in men who have sex with men.Dis Colon Rectum. 2009; 52: 507-512Crossref PubMed Scopus (33) Google Scholar, 3McMillan A. Lee F.D. Sigmoidoscopic and microscopic appearance of the rectal mucosa in homosexual men.Gut. 1981; 22: 1035-1041Crossref PubMed Scopus (71) Google Scholar In addition, clinical information is invaluable to the pathologist for adequate histopathologic examination of the rectal biopsies, which should include special stains for micro-organisms.

C1 Pharyngeal lymphogranuloma venereum: four cases in men who have sex with men

BackgroundLymphogranuloma venereum (LGV) is an established cause of proctitis in men who have sex with men (MSM). In the UK, testing for pharyngeal Chlamydia trachomatis (CT) is not routine, and...

Non-inflammatory remarks

Lymphogranuloma venereum (LGV), caused by infection with Chlamydia trachomatis L1-3 serovars, has emerged as a cause of proctitis amongst men who have sex with men (MSM) in much of the developed world. In Western Europe a marked and persistent increase in cases of rectal LGV has been seen amongst men who have sex with men (MSM) since 2003. During this time the epidemiology of LGV in the UK has evolved from sporadic, mostly imported, heterosexual infections to a sustained outbreak centred on London and Brighton primarily affecting HIV-positive MSM.

Testing Men Who Have Sex With Men for Urethral Infection With Chlamydia trachomatis and Neisseria gonorrhoeae Is Only Half the Job, and We Need the Right Tools

Standard operating procedure in STD clinics commonly has been to test urethral specimens when evaluating males, whether they are heterosexual or men who have sex with men (MSM). Rectal or oropharyngeal specimens may be tested in MSM with symptoms, or in some clinics as screening tests if individuals report sexual practices that would indicate risk of infection at these sites. In a report in this issue of Sexually Transmitted Diseases, Marcus and colleagues studied the prevalence of infection with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in the urethra, the oropharynx, and rectum in asymptomatic MSM visiting the San Francisco STD clinic.1 A retrospective analysis of 3398 patient visits found CT or GC at 549 (16.2%) of those visits. The prevalence of infections among these asymptomatic men ranged from a high of 7.8% for rectal CT to a low of 0.4% for urethral GC. Strikingly, 83.8% of CT and GC infections would have been missed if only urethral screening was performed. What was found in the Marcus study, and in others, as well, is that the majority of infections with CT/GC in MSM are not in the urethra. The first major study to make this point was performed by Kent and colleagues, in 2 clinics in San Francisco, where they found that 50% of chlamydial and gonococcal infections were extraurethral.2 That finding has been confirmed by a number of approaches, including retrospective chart reviews and prospectively designed studies (Table 1). While these studies have focused on rectal and pharyngeal CT/GC infections in MSM, it must be noted that such infections are far from rare in women.12,13 In many clinical settings, the infections in women will be seen more often than those in men. These extragenital infections should not be ignored now, and we need more research to better define their potential consequences. Both CT and GC are recognized as causes of proctitis, and even asymptomatic infections have been associated with HIV transmission. 14 Current CDC recommendations call for routine screening of the oropharynx and rectum in MSM who may be exposed to GC or CT at those sites. It is not clear whether pharyngeal infections have a major direct impact on health. But evidence is emerging that infection can be transmitted from the oropharynx to the urethra of sex partners, thus continuing chains of infection.15 All of the cited studies have been made possible by the introduction and application of highly sensitive and specific nucleic acid amplification tests (NAATs) for the diagnosis of CT and GC infections. NAATs are recommended for routine diagnosis of CT/GC infections.15 Where direct comparisons have been done, it has been shown that the increment in sensitivity for NAATs as compared to culture is greater with pharyngeal and rectal specimens than it is with cervical and urethral specimens. An approximate doubling of the number of infections detected has been obtained with NAATs. 4,11 Alas, there remains a gap wherein the best tests are not readily available to the patients and providers who need them. Several NAATs are commercially available and have received FDA clearance for male and female urine specimens, urethral swabs from men, and cervical and vaginal swabs from women. Unfortunately, none have been cleared by the FDA for pharyngeal or rectal specimens. But the CDC, recognizing the superior performance of these tests used on these specimens, has taken an unusual step and recommended the use of NAATs for diagnosis of CT/GC in oropharyngeal and rectal specimens, even though such use has not received FDA clearance. 16 The

European guideline for the management of lymphogranuloma venereum, 2010

Lymphogranuloma venereum (LGV) has re-emerged among European men who have sex with men (MSM) in recent years and is probably endemic in this population where it is a relatively common cause of proctitis and occasional genital ulcer-adenopathy disease. While occasional cases of heterosexual LGV are seen in Europe these have usually been imported from endemic countries.

Lymphogranuloma venereum proctitis masquerading as inflammatory bowel disease in 12 homosexual men

Lymphogranuloma venereum (LGV) is a recognized cause of proctitis. Symptoms, endoscopy and histology findings are similar in IBD and LGV proctitis. To characterize the clinical, endoscopic and histological features seen in men diagnosed initially with IBD and subsequently with LGV proctitis, and to attempt isolation of Chlamydia trachomatis DNA from the stored rectal biopsy specimens of these patients using real-time PCR. Clinical data were collated from confirmed or suspected cases of LGV proctitis where endoscopy and biopsy had been performed as part of the investigation of clinical symptoms. LGV was confirmed by the detection of LGV-specific DNA from rectal swab specimens, with supportive evidence from Chlamydial serology. Stored histological specimens from rectal biopsies were analysed retrospectively for LGV-specific DNA with molecular techniques. Rectal biopsies had been obtained from twelve cases of LGV proctitis. Mucosal ulcers, cryptitis, crypt abscesses and granulomas were common histological findings. Extraction of LGV-specific DNA from rectal biopsy specimens enabled confirmation of three suspected cases. During the recent LGV proctitis epidemic among UK men who have sex with men, it has become apparent that this infection may closely resemble IBD. Gastroenterologists should remain alert to LGV as a cause of proctitis in this group.

PWE-039 Lymphogranuloma venereum proctitis masquerading as inflammatory bowel disease in 12 homosexual men

<h3>Introduction</h3> Lymphogranuloma venereum (LGV) is a recognised cause of proctitis which can be difficult to distinguish clinically and histologically from inflammatory bowel disease (IBD). The condition was first described in 2004, following an outbreak in The Netherlands. Lymphogranuloma venereum (LGV) proctitis is caused by L1, L2 and L3 serovars of CT and has evaded detection in recent decades in developed countries. <h3>Aim</h3> We describe a case series of LGV proctitis seen among HIV-positive men who have sex with men (MSM) who underwent endoscopy and biopsy and were diagnosed provisionally with IBD. <h3>Methods</h3> A retrospective study was performed in an inner London hospital. Clinical data were collated from confirmed or suspected cases of LGV proctitis where endoscopy and biopsy had been performed as part of the investigation of clinical symptoms. LGV was confirmed by the detection of LGV-specific DNA from rectal swab specimens, with supportive evidence from Chlamydia serology. Stored histological specimens from rectal biopsies were analysed retrospectively for LGV-specific DNA with the use of molecular techniques. <h3>Results</h3> All 12 cases were in HIV positive homosexual men, median age 41.5 years (range 27–55). In all twelve cases of LGV proctitis rectal biopsies had been obtained. All patients were symptomatic at the time of endoscopy and endoscopic features of proctitis were present in 10 of 12 cases. Mucosal ulceration, cryptitis, crypt abscesses and granulomas were common histological findings but crypt distortion, where seen, was usually mild: in most cases these findings were attributed initially to IBD. All cases were reviewed in gastroenterology or colorectal surgical clinics, where provisional diagnosis of IBD or non-specific proctitis were made. Eight patients were commenced on courses of metronidazole or 5-aminosalicylates. Two patients were given courses of prednisolone. Extraction of LGV-specific DNA from rectal biopsy specimens enabled confirmation of three cases of suspected LGV. <h3>Conclusion</h3> During the recent epidemic of LGV proctitis among UK MSM, it has become apparent that the clinical, endoscopic and histological features of the infection may closely resemble IBD and this may obscure the diagnosis. Relevant clinicians and pathologists should be alerted to the current epidemiology and clinical features of LGV in the UK.

Sexually Transmitted Infections as a Cause of Proctitis in Men Who Have Sex with Men

Many men who have sex with men (MSM) present with complaints of bleeding, pain, and inflammation. We endeavored to determine the incidence of sexually transmitted infections in MSM referred for treatment of these symptoms and the effect of empiric therapy. A retrospective chart review of all MSM seen in 2007 at one surgical practice diagnosed with presumptive proctitis was performed. All MSM are routinely tested for sexually transmitted infections. Twenty-six MSM were identified (mean age, 38 years), and 17 (65 percent) were HIV+. Bleeding and pain were the most common complaints seen in 19 (73 percent) and 16 (62 percent), respectively. The most common findings were discharge in 15 (58 percent) and blood in 14 (54 percent). Sexually transmitted infections were identified in 21 (86 percent) and 3 (11 percent) had unidentified etiology. Gonorrhea was found in eight (43 percent), herpes simplex virus in six (29 percent), lymphogranuloma venereum in four (19 percent), and two each (10 percent) had Chlamydia and syphilis. Three had multiple infections. All but two treated empirically responded without complication and they had Crohn's colitis (n = 1) and rectal lymphoma (n = 1). Sexually transmitted infections are a common cause of proctitis and appropriate testing is imperative. Lymphogranuloma venereum is a common cause. Empiric treatment leads to rapid resolution and diminishes the chance for spread.

Antibiotic Use in Sexually Transmissible Diseases

Sexually transmissible diseases (STDs) remain a major health issue worldwide, with approximately 300 million new cases annually. STDs caused by bacteria can be treated with antibiotics, although the susceptibility pattern of many etiologic microbes has changed over the past few decades. Syphilis remains best managed with single-dose benzathine penicillin G. Other single-dose antibiotic regimens for lues are either associated with clinical failure or of uncertain dosage. However, single-dose azithromycin and ceftriaxone are suitable for chancroid. Lymphogranuloma venereum, reemergent as a cause of proctitis, is treated with prolonged courses of doxycycline or minocycline. Trimethoprim-sulfamethoxazole has replaced tetracycline derivatives as preferred treatment for donovanosis in many regions. Parenteral cephalosporins, such as ceftriaxone, cefotaxime, and ceftizoxime, are initial interventions for disseminated gonococcemia. Pending culture results, genital bite wounds (often consisting of deep, painful ulcerations) should be treated with high-dose amoxicillin-clavulanic acid.

Prevalence of rectal Trichomonas vaginalis and Mycoplasma genitalium in male patients at the San Francisco STD clinic, 2005-2006.

SEXUALLY TRANSMITTED INFECTIONS (STI), such as Chlamydia trachomatis, Neisseria gonorrhoeae, herpes simplex virus (HSV), and Treponema pallidum are common causes of proctitis among gay men and other men who have sex with men (MSM).1,2 Inflammatory proctitis caused by an STI may increase the suscepti