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"Proctitis & Anusitis, Infectious." Quick Answers Surgery Doherty GM. Doherty G.M. Ed. Gerard M. Doherty. New York, NY: McGraw-Hill, 2010, http://accesssurgery.mhmedical.com/content.aspx?bookid=853§ionid=49662246. Download citation file: RIS (Zotero) EndNote BibTex Medlars ProCite RefWorks Reference Manager © Copyright Tools Search Book Top Return Clip Proctitis & Anusitis, Infectious + Essential Features Print Section + • Proctitis and anusitis are nonspecific terms for varying degrees of inflammation due to infectious or inflammatory diseases• Causative agent or event determines the symptoms, signs, and appropriate management• Attention to sexual practices and sexually transmitted diseases ++ Herpes Proctitis + • Lesions appear as vesicles, which rupture to form ulcers• Ulcers that may become secondarily infected• Commonly caused by herpes simplex virus type 2 (HSV-2)• Transmitted by sexual contact ++ Anorectal Syphilis + • Chancre is an indurated, nontender perianal ulcer at the site of inoculation• Proctitis, pseudotumors, and condylomata lata may be present ++ Gonococcal Proctitis + • The gram-negative diplococcus Neisseria gonorrhoeae is the causative agent• Commonly symptomatic in men, less often in women ++ Chlamydial Proctitis and Lymphogranuloma Venereum + • Causative agent is Chlamydia trachomatis ++ Chancroid: Haemophilus ducreyi + • Soft ulcer and local lymphadenitis ++ Epidemiology ++ Herpes Proctitis + • No history of anoreceptive intercourse is required because the disease may spread by extension from the vagina• Number of HSV-2 infections rising ++ Anorectal Syphilis + • Transmitted from spirochete-containing lesions of skin or mucous membranes• Marked increase in incidence of disease in homosexual men in recent years ++ Gonococcal Proctitis + • More common in women and homosexual men ++ Chlamydial Proctitis and Lymphogranuloma Venereum + • Spread by anal intercourse or direct extension through the lymphatics of the rectovaginal septum ++ Chancroid: H ducreyi + • Autoinoculation is common• More common in tropical countries, rare in United States + Clinical Findings Print Section ++ Symptoms and Signs ++ Herpes Proctitis + • Patients may present early with anal pain and vesicles or later with ulcerations, discharge, rectal bleeding, tenesmus, and even fear of defecation because of severe pain• Fever and generalized malaise• Inguinal adenopathy ++ Anorectal Syphilis + • Patients present with chancre, a nontender ulcer at the site of inoculation and proctitis ++ Gonococcal Proctitis + • Symptoms range from none to painful defecation• Rectal bleeding and discharge, perianal excoriation, and fistulas may develop• Mucosa may appear friable and edematous ++ Chlamydial Proctitis and Lymphogranuloma Venereum + • Symptoms of chlamydial proctitis range from none to rectal pain, bleeding, and discharge• Small shallow ulcer• Inguinal adenopathy may be quite marked• Late findings include hemorrhagic proctitis and rectal stricture ++ Chancroid: H ducreyi + • Soft perianal ulcer that is painful, often multiple, and bleeds easily• Inguinal lymph nodes become fluctuant, rupture, and drain• Associated painful penile lesions ++ Laboratory Findings ++ Herpes Proctitis + • Viral culture of the vesicle or biopsy of the ulcer is diagnostic• Diagnosis from skin lesion can be made using Tzanck smear• Multinucleated giant cells suggest herpesvirus infection ++ Anorectal Syphilis + • Darkfield microscopy of exudate and serologic testing are the preferred methods of diagnosis• Serologic tests (VDRL and rapid plasmin reagin [RPR]) may initially be negative and should be repeated several months later• Specific treponemal antigen tests (FTA-ABS) ++ Gonococcal Proctitis + • Culture on Thayer-Martin medium reveals gram-negative diplococci• ELISA and DNA probe assays are available ++ Chlamydial Proctitis and Lymphogranuloma Venereum + • The diagnosis is made with the LGV complement fixation test; tissue cultures are also used• Chlamydiae form cytoplasmic inclusions seen in Giemsa stain and immunofluorescence ++ Chancroid: H ducreyi + • Culture on heated blood agar supplemented with factor X is diagnostic + Diagnostic Considerations Print Section + • Concomitant/multiple concurrent infections + Work-up Print Section + • History and physical exam-Particular attention should be paid to sexual practices and sexually transmitted diseases• Cultures of the anus, vagina, urethra, and pharynx should be obtained + Treatment and Management Print Section ++ Herpes Proctitis + • Oral acyclovir is the treatment of choice but is not curative ++ Anorectal Syphilis + • Penicillin is the treatment of choice (tetracycline or erthyromycin are alternatives) ++ Gonococcal Proctitis + • Intramuscular procaine penicillin G and oral probenecid; resistant strains should be treated with spectinomycin ++ Chlamydial Proctitis and Lymphogranuloma Venereum + • Treatment with 21 days of tetracycline is recommended, but erythromycin is an acceptable alternative ++ Chancroid: H ducreyi + • Azithromycin, erythromycin, ciprofloxacin, or ceftriaxone ++ Surgery ++ Indications + • Strictures may require dilation• Although uncommon, strictures may cause bowel obstruction and require colostomy ++ Treatment Monitoring + • Follow-up exam and cultures should be performed to confirm adequate therapy ++ Complications ++ Anorectal Syphilis + • Progression to tertiary syphilis with nervous system and cardiovascular organ involvement ++ Chlamydial Proctitis and Lymphogranuloma Venereum + • May progress to urethritis, cervicitis, salpingitis, pelvic inflammatory disease (PID) ++ Gonococcal Proctitis + • Ascending infection, urethritis, PID, cervicitis, septic arthritis ++ Prognosis ++ Herpes Proctitis + • No drug treatment prevents recurrences ++ Anorectal Syphilis + • Good ++ Gonococcal Proctitis + • Excellent ++ Prevention + • Contacts must be sought, tested, and treated• Avoidance of contact with lesions and ulcers + Resources Print Section ++ References ++Chang GJ, Welton ML: Human papillomavirus, condylomata acuminata, and anal neoplasia. Clin Colon Rectal Surg 2004;17:55. ++Centers for Disease Control and Prevention: Sexually transmitted diseases treatment guidelines 2002. MMWR 2002;51. ++Hakim AA et al: Indications and efficacy of the human papillomavirus vaccine. Curr Treat Options Oncol 2007;6:393.