Separating Infectious Proctitis from Inflammatory Bowel Disease-A Common Clinical Conundrum

Area of Science:

• Gastroenterology
• Infectious Diseases
• Sexual Health

Background:

• Proctitis, rectal inflammation, presents with bleeding, discharge, and pain.
• Common causes include sexually transmitted infections (STIs) and inflammatory bowel disease (IBD).
• Infective proctitis incidence is increasing, particularly in men who have sex with men and HIV-positive individuals.

Purpose of the Study:

• To compare and highlight distinguishing features of inflammatory and infective proctitis.
• To provide a practical guide for clinicians to avoid misdiagnosis.
• To focus on key clinical and diagnostic features for accurate differentiation.

Main Methods:

• Review of clinical presentations of proctitis.
• Comparison of endoscopic and histological features of infective vs. inflammatory causes.
• Analysis of common causative organisms in infective proctitis.

Main Results:

• Significant overlap exists between infective proctitis and IBD presentations.
• Common infective organisms include *Neisseria gonorrhoeae*, *Chlamydia trachomatis*, *Treponema palladium*, HSV, and *Mycoplasma genitalium*.
• Mpox outbreak also identified proctitis as a feature.

Conclusions:

• Distinguishing infective proctitis from IBD is a clinical challenge.
• Focusing on specific clinical and diagnostic hallmarks is crucial for accurate diagnosis.
• This review aids clinicians in differentiating proctitis causes to prevent misdiagnosis.