Proctitis
Basic Information
Proctitis is an inflammation of the rectum or rectal mucosa and the tissues surrounding the anus. It is a sexually transmitted disease (STD) belonging to the gastrointestinal syndrome of STDs. There are other causes beside STDs but the majority of cases come from sexual transmission and usually affect gay males or men who have sex with other men, especially those who engage in anal intercourse.
Those patients who have HIV are at special risk for proctitis and their infections are usually caused by herpes simplex virus or CMV. In immunocompromised patients, the herpes proctitis is often quite severe.
Sexually transmitted causes of proctitis include:
Also, but less frequently:
- syphilis (usually secondary)
- amebiasis
- campylobacter
- shigella
- salmonella
- candidiasis
Males at greatest risk are those who have sex with other men and engage in anal intercourse, and though any male from adolescents to older adults is at risk, most cases occur among men in their 30s and early 40s. Other causes besides STDs may cause proctitis but these cases are associated with such risk factors as:
- use or overuse of laxatives
- previous use of antibiotics
- radiation therapy
- rectal injury followed by rectal medications
- chronic constipation
- allergies to specific foods
Proctitis is important to treat because left untreated complications such as chronic ulcerative colitis, anal scarring or anal stricture (in which the anus narrows permanently) may occur.
Symptoms
Symptoms may include:
- rectal pain -- if the cause of proctitis is due to gonorrhea, CMV or herpes simplex, the pain may be intense
- rectal bleeding
- mucousy rectal discharge
- urge to move the bowels -- often constant even if no stool is present
- cramps in the lower abdomen, normally on the left side
Diagnosis/Treatment
Diagnosis includes identifying the underlying cause. Laboratory tests for sexually transmitted diseases will help specify the specific STD that is probably causing your case of proctitis. Blood counts and stool cultures are usually indicated. Also an anoscopy, proctoscopy and sigmoidoscopy may be used to investigate additional causes as well as to evaluate the inflammation itself. Your health care provider will be looking for anorectal pus to help make the diagnosis.
Treatment depends on the cause of your proctitis -- in most cases when an STD is identified you will be treated specifically for that STD. Infections will usually resolve with antibiotic treatment and follow-up may be indicated to be certain the infection has been eradicated. It is important not to engage in anal sex during the treatment stage so that your health care provider can tell whether the medications are helping you or not and that if you are not improving with medications it is not because of reinfection. Generally antibiotic treatment for HIV positive and HIV negative men is the same.
Do not have sex with your partner or other partners until your infection has been cleared up and let your recent sexual partner or partners know if you have been diagnosed with proctitis so that they may also be tested.
Also the presence of one STD indicates that another may be present so that if you are diagnosed with proctitis you should be tested for herpes, hepatitis, gonorrhea, syphilis and chlamydia. A discussion about HIV is also advised and an HIV test may be advisable.