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  • • 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

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Herpes Proctitis

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  • • 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

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Anorectal Syphilis

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  • • Chancre is an indurated, nontender perianal ulcer at the site of inoculation

    • Proctitis, pseudotumors, and condylomata lata may be present

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Gonococcal Proctitis

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  • • The gram-negative diplococcus Neisseria gonorrhoeae is the causative agent

    • Commonly symptomatic in men, less often in women

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Chlamydial Proctitis and Lymphogranuloma Venereum

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  • • Causative agent is Chlamydia trachomatis

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Chancroid: Haemophilus ducreyi

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  • • Soft ulcer and local lymphadenitis

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Epidemiology

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Herpes Proctitis

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  • • No history of anoreceptive intercourse is required because the disease may spread by extension from the vagina

    • Number of HSV-2 infections rising

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Anorectal Syphilis

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  • • Transmitted from spirochete-containing lesions of skin or mucous membranes

    • Marked increase in incidence of disease in homosexual men in recent years

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Gonococcal Proctitis

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  • • More common in women and homosexual men

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Chlamydial Proctitis and Lymphogranuloma Venereum

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  • • Spread by anal intercourse or direct extension through the lymphatics of the rectovaginal septum

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Chancroid: H ducreyi

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  • • Autoinoculation is common

    • More common in tropical countries, rare in United States

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Symptoms and Signs

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Herpes Proctitis

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  • • 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

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Anorectal Syphilis

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  • • Patients present with chancre, a nontender ulcer at the site of inoculation and proctitis

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Gonococcal Proctitis

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  • • Symptoms range from none to painful defecation

    • Rectal bleeding and discharge, perianal excoriation, and fistulas may develop

    • Mucosa may appear friable and edematous

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Chlamydial Proctitis and Lymphogranuloma Venereum

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  • • 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

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Chancroid: H ducreyi

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  • • Soft perianal ulcer that is painful, often multiple, and bleeds easily

    • Inguinal lymph nodes become fluctuant, rupture, and drain

    • Associated painful penile lesions

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Laboratory Findings

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Herpes ...

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