Proctitis & Anusitis, Infectious

• • 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

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, ...