Proctitis is defined as an inflammation of the rectal mucosa, which is the tissue identified between the anal canal and the colon. Many infections involve the anus as well and are therefore considered “anorectal” infections. Although STD-related rectal infections are frequently associated with anal intercourse among homosexual men, they may also occur in women. Such infections in women are less well defined and, with gonorrhea, are often asymptomatic and associated with endocervical gonorrhea. The microbiological etiologic agents of anorectal infection among sexually active adolescents include N. gonorrhoeae, C. trachomatis (lymphogranuloma venereum, LGV, strains), HSV, T. pallidum, and food-borne enteric organisms. Sexually transmitted enteric organisms, such as Giardia, Entamoeba, Campylobacter, Shigella, and hepatitis A, can be associated with anal intercourse. HIV-infected individuals may also have severe herpes proctitis or be infected with organisms generally not sexually transmitted, including CMV, Mycobacterium avium-intracellulare, and others.
Whereas the anus is highly innervated, resulting in pain with inflammation, the rectum lacks such innervation; thus, proctitis that does not involve the anus is usually painless. Symptoms of anorectal disease include mucus or blood in the stools, loose stool, cramping, anal itching, pain with defecation leading to constipation, and tenesmus. On examination, the anus may appear inflamed and tender. Mucopurulent discharge with or without blood may be present. Anoscopy may reveal the presence of mucopurulent discharge and erythema of the mucosa with friability and ulceration. Diagnostic evaluation includes a careful sexual history to determine risk for anal intercourse; STDs; testing for STD-related urethritis in men (Fig. 3-6) and endocervicitis in women (Fig. 3-7); rectal cultures for N. gonorrhoeae, C. trachomatis, and HSV; appropriate stool and rectal specimens for enteric bacteria and parasites; and syphilis serology (
Table 3-16 and depends on the etiologic agent responsible.
Sexually Transmitted Diseases
BERGER RE , ALEXANDER ER , HARNISCH JP , et al: Etiology, manifestations and therapy of acute epididymitis: Prospective study of 50 cases. J Urol 121:750-754, 1979
BLAKE DR , DUGGAN A , QUINN T , ZENILMAN J , JOFFE A . Evaluation of vaginal infections in adolescent women: can it be done without a speculum? Pediatrics 102:939-944, 1998
BROKER TR , BOTCHAN M: Papillomaviruses: Retrospectives and prospectives on cancer cells 4. Cold Springs Harbor Laboratory 17-36, 1986
BURGHER SW: Acute scrotal pain. Emerg Med Clin North Am 16:781- 809, 1998
CAMPION MJ: Clinical manifestations and natural history of genital human papillomavirus infection. Obstet Gynecol Clin North Am 14:363-388, 1987
Centers for Disease Control and Prevention: Chlamydia trachomatis genital infections. United States, 1995. Morb Mortal Wkly Rep 46:193-198, 1997
Centers for Disease Control and Prevention: 1998 Sexually transmitted disease treatment guidelines. Morb Mortal Wkly Rep 47:1-116, 1998
CHERNESKY MA: Nucleic acid tests for the diagnosis of sexually transmitted diseases. FEMS Immunol Microbiol 24(4):437-46, 1999
COREY L , SPEAR PG: Infections with herpes simplex viruses, part II. N Engl J Med 314:749-757, 1986
Division of STD Prevention: Sexually Transmitted Disease Surveillance, 1998. US Department of Health and Human Services, Public Health Service. Atlanta; Centers for Disease Control and Prevention, September 1999.
WASHINGTON AE , GOVES S , SCHACHTER J , et al: Oral contraceptives, Chlamydia trachomatis infection and pelvic inflammatory disease. A word of caution about protection. JAMA 124:2246-2250, 1985
Sexually Transmitted Infections
- Sexually Transmitted Infections
- Age, Gender, Ethnicity
- Contraceptives and Sexually Transmitted Diseases
- Clinical Aspects of Sexually Transmitted Diseases
Revision date: July 9, 2011
Last revised: by Janet A. Staessen, MD, PhD