Proctitis, sexually-transmitted

Proctitis, sexually-transmitted is caused mainly by gonococcal, chlamydial, LGV, herpes, and syphilitic organisms. Symptoms are rectal pain and discharge (mucopurulent or bloody) with tenesmus and constipation. Proctocolitis and enteritis more often cause diarrhea.

CASES/YEAR
22,500 (US); 450,000 (Global)
AGENT TYPE
Mixed
OTHER NAMES
ACUITY
Acute-Severe
INCUBATION
Estimated: 1 day to several weeks;
INITIAL SYMPTOMS
Rectal pain and discharge (mucopurulent or bloody) with tenesmus and constipation; Proctocolitis and enteritis more often cause diarrhea; [Harrisons, p. 423]
PRECAUTIONS
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]
SCOPE
Global
SIGNS & SYMPTOMS
  • >arthralgia
  • >fever
  • >myalgia
  • G abdominal pain
  • G blood in stool
  • G constipation
  • G diarrhea
  • G fecal leukocytes
  • H lymphadenopathy
  • S pustule
  • S ulcer of skin
  • S warty growth of the skin
ANTIMICROBIC

Yes

VACCINE

No

ENTRY
Sexual Contact
SOURCE
Person-to-Person
RESERVOIR
Human
RISK FACTORS
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. According to a survey in the UK in 2010 by the Office for National Statistics, 1.5% of Britons identified themselves as homosexual or bisexual. [Wikipedia] Guesstimate: Assume 1.5% of males are homosexual, and 1% develop infectious proctitis every year; Calculate: 1.5% X 3 billion = 45 million: 1% X 45 million = 450,000;