Proctitis: Difference between revisions
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===[[Gonorrhea]]=== | ===[[Gonorrhea]]=== | ||
*Symptoms vary from none to severe rectal pain | *Symptoms vary from none to severe rectal pain with yellow, bloody discharge | ||
*Unlike nonvenereal cryptitis, infection is not confined to the posterior crypt | *Unlike nonvenereal cryptitis, infection is not confined to the posterior crypt | ||
*Diagnosis made by Gram stain and culture | *Diagnosis made by Gram stain and culture | ||
*Also consider dissemination to heart, liver, CNS, and joints | *Also consider dissemination to heart, liver, CNS, and joints | ||
*Treatment: [[ceftriaxone]] 125mg IM + | *Treatment: [[ceftriaxone]] 125mg IM + [[azithromyci]]n 2gm PO single dose | ||
===[[Chlamydia]]=== | ===[[Chlamydia]]=== | ||
*Infection | *Infection due to direct anorectal infection or via vaginal seeding to perirectal lymphatics | ||
*Symptoms range from asymptomatic to anal pruritus, pain, purulent discharge | *Symptoms range from asymptomatic to anal pruritus, pain, purulent discharge | ||
*Lymphogranulomatous variety | *Lymphogranulomatous variety | ||
**Acutely painful anal ulcerations a/w unilateral lymph node enlargement | **Acutely painful anal ulcerations a/w unilateral lymph node enlargement | ||
**Fever and flulike symptoms | **[[Fever]] and flulike symptoms | ||
**May result in rectal scarring, stricturing, perirectal abscesses, chronic fistulas | **May result in rectal scarring, stricturing, perirectal abscesses, chronic fistulas | ||
*Treatment | *Treatment | ||
**Non-LGV: Azithromycin 2gm PO x1 or doxycycline 100mg PO BID x7d | **Non-LGV: [[Azithromycin]] 2gm PO x1 or [[doxycycline]] 100mg PO BID x7d | ||
**LGV: Doxycyline 100mg PO BID x21d | **LGV: [[Doxycyline]] 100mg PO BID x21d | ||
===[[Syphilis]]=== | ===[[Syphilis]]=== | ||
*Primary | *Primary | ||
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**Condylomata lata (flatter and firmer than condylomata acuminata) | **Condylomata lata (flatter and firmer than condylomata acuminata) | ||
*Treatment | *Treatment | ||
**Penicillin G 2.4mil IM x1 | **[[Penicillin]] G 2.4mil IM x1 | ||
===[[Herpes Simplex Virus-2]]=== | ===[[Herpes Simplex Virus-2]]=== | ||
*Itching and soreness in perianal area progressing to severe anorectal pain | *Itching and soreness in perianal area progressing to severe anorectal pain | ||
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**Vesicles then enlarge, coalesce, and rupture, forming exquisitely tender ulcers | **Vesicles then enlarge, coalesce, and rupture, forming exquisitely tender ulcers | ||
*Treatment | *Treatment | ||
**Acyclovir 400mg PO TID x10d for initial episode; 800mg TID x2d for recurrent episodes | **[[Acyclovir]] 400mg PO TID x10d for initial episode; 800mg TID x2d for recurrent episodes | ||
==See Also== | ==See Also== | ||
Revision as of 06:59, 30 August 2015
Background
Causes
- Radiation tx
- Autoimmune
- Vasculitis
- Ischemia
- Infectious (STI and enteric organisms)
Clinical Features
- Inflammation of the rectal mucosa
Differential Diagnosis
Anorectal Disorders
- Anal fissure
- Anal fistula
- Anal malignancy
- Anal tags
- Anorectal abscess
- Colorectal malignancy
- Condyloma acuminata
- Constipation
- Crohn's disease
- Cryptitis
- GC/Chlamydia
- Hemorrhoids
- Pedunculated polyp
- Pilonidal cyst
- Proctitis
- Pruritus ani
- Rectal foreign body
- Rectal prolapse
- Syphilitic fissure
Diagnosis and Treatment
Condyloma Acuminata
Gonorrhea
- Symptoms vary from none to severe rectal pain with yellow, bloody discharge
- Unlike nonvenereal cryptitis, infection is not confined to the posterior crypt
- Diagnosis made by Gram stain and culture
- Also consider dissemination to heart, liver, CNS, and joints
- Treatment: ceftriaxone 125mg IM + azithromycin 2gm PO single dose
Chlamydia
- Infection due to direct anorectal infection or via vaginal seeding to perirectal lymphatics
- Symptoms range from asymptomatic to anal pruritus, pain, purulent discharge
- Lymphogranulomatous variety
- Acutely painful anal ulcerations a/w unilateral lymph node enlargement
- Fever and flulike symptoms
- May result in rectal scarring, stricturing, perirectal abscesses, chronic fistulas
- Treatment
- Non-LGV: Azithromycin 2gm PO x1 or doxycycline 100mg PO BID x7d
- LGV: Doxycyline 100mg PO BID x21d
Syphilis
- Primary
- Anal chancres are often painful
- May be misdiagnosed as simple fissure
- Symmetric lesion on opposite side of anal margin is distinguishing feature
- Inguinal adenopathy is often present
- May be misdiagnosed as simple fissure
- Anal chancres are often painful
- Secondary
- Condylomata lata (flatter and firmer than condylomata acuminata)
- Treatment
- Penicillin G 2.4mil IM x1
Herpes Simplex Virus-2
- Itching and soreness in perianal area progressing to severe anorectal pain
- Accompanied by flulike illness, inguinal adenopathy
- Early lesions are small, discrete vesicles on erythematous base
- Vesicles then enlarge, coalesce, and rupture, forming exquisitely tender ulcers
- Treatment
- Acyclovir 400mg PO TID x10d for initial episode; 800mg TID x2d for recurrent episodes