Proctitis

Background

  • Inflammation of the rectal mucosa
  • Causes
    • Radiation tx
    • Autoimmune
    • Vasculitis
    • Ischemia
    • Infectious (STI and enteric organisms)

Types

Condyloma Acuminata

Gonorrhea

  • Symptoms vary from none to severe rectal pain w/ 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: CTX 125mg IM + azithromycin 2gm PO single dose

Chlamydia

  • Infection d/t 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
  • 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

Differential Diagnosis

Anorectal Disorders

See Also

Source

Tintinalli

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