Syphilitic proctitis presenting as rectal bleeding

Syphilitic proctitis is an uncommon presentation of Treponema pallidum infection and can closely resemble other anorectal conditions. Due to its non-specific symptoms, it is often underdiagnosed, particularly in individuals without systemic manifestations. A male patient in his 30s presented with isolated rectal bleeding. Sigmoidoscopy revealed multiple superficial ulcers over the folds of the anal canal, along with erythematous rectal mucosa and focal erosions. Given the patient's history of unprotected sexual intercourse, serological testing was performed. The Venereal Disease Research Laboratory test and histopathology from the rectal ulcers confirmed the diagnosis of syphilitic proctitis. The patient was treated successfully with intramuscular benzathine penicillin, resulting in complete resolution of symptoms. This case underscores the importance of considering T. pallidum infection in patients with unexplained rectal bleeding, particularly those with a history of unprotected sexual activity. Early recognition and appropriate antibiotic therapy are essential to prevent complications and limit transmission.