Proctitis

Background

Causes

  • Radiation treatment
  • Autoimmune
  • Vasculitis
  • Ischemia
  • Infectious (STI and enteric organisms)

Clinical Features

  • Inflammation of the rectal mucosa
  • Pain on defecation
  • Tenesmus
  • Mucoid discharge
  • Inguinal lymphadenopathy (may be seen with T. pallidum)

Differential Diagnosis

Anorectal Disorders

Evaluation and Management

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 associated with unilateral lymph node enlargement
    • Fever and flulike symptoms
    • May result in rectal scarring, stricturing, perirectal abscesses, chronic fistulas
  • Treatment

Syphilis

  • Primary
    • Anal chancres appear ~2-6 wks after intercourse, 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

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

See Also

References