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Infectious proctitis: when to suspect it is not inflammatory bowel disease
Frank Hoentjen1, David T Rubin
1Inflammatory Bowel Disease Center, University of Chicago Medical Center, 5841 S. Maryland Avenue, MC4076, Chicago, IL 60637, USA. Frankhoentjen@gmail.com
Background:
Proctitis is a common problem and is most frequently associated with inflammatory bowel diseases. However, the incidence of infectious proctitis appears to be rising, especially in men who have sex with men. This may be due to the rise of people participating in receptive anal sex as well as the increase in sexually transmitted infections. The most frequently reported pathogens include Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, and herpes simplex.
Diagnosis:
Symptoms of infectious proctitis can include rectal blood and mucous discharge, anorectal pain, ulcers, and occasionally lymphadenopathy and fever. History and physical examination are crucial in establishing a diagnosis, supported by endoscopy, histology, serology, culture and PCR.
Treatment:
Treatment with antibiotics or antivirals is usually initiated, either empirically or after establishing a diagnosis. Co-infections, HIV testing, and treatment of sexual partners should always be considered.
Insights
Infectious proctitis, often seen in men who have sex with men, is rising due to increased sexually transmitted infections. Early diagnosis and treatment with antibiotics or antivirals are key for managing this condition.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Public Health
Background:
- Proctitis is commonly linked to inflammatory bowel diseases.
- Infectious proctitis incidence is increasing, particularly among men who have sex with men.
- Rising rates are associated with receptive anal sex and increased sexually transmitted infections (STIs).
Purpose of the Study:
- To highlight the rising incidence of infectious proctitis.
- To outline diagnostic methods for infectious proctitis.
- To emphasize treatment considerations for infectious proctitis.
Main Methods:
- Diagnosis involves a thorough history and physical examination.
- Endoscopy, histology, serology, culture, and PCR support diagnosis.
- Empirical or targeted antibiotic/antiviral treatment is initiated.
Main Results:
- Common pathogens include Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, and herpes simplex.
- Symptoms may include rectal bleeding, discharge, pain, ulcers, lymphadenopathy, and fever.
- Consideration of co-infections, HIV testing, and partner treatment is essential.
Conclusions:
- Infectious proctitis requires prompt diagnosis and management.
- Public health efforts should address rising STI rates in at-risk populations.
- Comprehensive care includes partner notification and treatment.
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