COMMENTS
The main infections are gonococcal, chlamydial, LGV, herpes, and syphilitic. Untreated LGV proctitis/proctocolitis (outbreaks reported in several European countries) may cause tissue destruction that resembles Crohn's disease. Patients with HSV proctitis may have urinary retention, rectal pain, and constipation. Primary syphilis can cause a perianal chancre but not proctitis. In the primary stage of LGV proctitis, pustules or ulcers may be present. Perianal condylomata lata are seen in syphilitic cases. [ABX Guide] Gonococcal infection of the rectum is usually asymptomatic, but some patients have rectal pain, itching, discharge, and bleeding. Patients with HSV proctitis have pain, discharge, and constipation. "C. trachomatis genital serovars D through K can cause proctitis, but this rectal infection is not as severe as LGV proctitis." Patients with LGV infection have pain, bleeding, and fever. [PPID, 8th Ed. p. 1719-20, 2163, 2169, 2455] Other causes of sexually-transmitted anorectal disease are granuloma inguinale, E. histolytica, Isospora belli, and chancroid. Proctitis caused by non-LGV C. trachomatis is usually asymptomatic. [Cecil, p. 939, 1980] Campylobacter or Shigella species are the most common causes of sexually-acquired proctocolitis. In male patients without AIDS, Giardia lamblia is a common cause of sexually-transmitted enteritis. [Harrisons, p. 423]
DIAGNOSTIC
Anoscopy; Gram stain and cultures (gonorrhea, chlamydia, herpes); Dark-field exam for spirochetes; Syphilis & Chlamydia LGV serology; validated NAATs are tests of choice for rectal gonorrhea & chlamydia; [ABX Guide]
REFERENCES FOR CASES/YEAR
1. (US) 1/20 of global cases/yr = 1/20 X 450,000 = 22,500;
2. (Global) "Diarrhea and acute proctitis are common problems for homosexual men." [ID, p. 600] No statistics were found. Guesstimate: 450,000 cases/year;