Proctitis: Difference between revisions
(Prepared the page for translation)
 
(29 intermediate revisions by 7 users not shown)
Line 1: Line 1:
<languages/>
<translate>
==Background==
==Background==
===Causes===
*Radiation treatment
*Autoimmune
*Vasculitis
*Ischemia
*Infectious ([[Special:MyLanguage/STI|STI]] and enteric organisms)
==Clinical Features==
===General===
*Inflammation of the rectal mucosa
*Inflammation of the rectal mucosa
*Causes
*Pain on defecation
**Radiation tx
*Tenesmus
**Autoimmune
*Mucoid discharge
**Vasculitis
*Inguinal lymphadenopathy (may be seen with [[Special:MyLanguage/Syphilis|T. pallidum]])
**Ischemia
 
**Infectious (STI and enteric organisms)
 
==Types==
===By Causative Agent===
===Condylomata Acuminata===
 
*Also known as anal warts
*[[Special:MyLanguage/Condyloma Acuminata|Condyloma Acuminata]]
*Vary from dot-like to large papilliform, cauliflower-like lesions
*[[Special:MyLanguage/Gonorrhea|Gonorrhea]]
*Pain, itching, bleeding, anal discharge
**Symptoms vary from none to severe rectal pain with yellow, bloody discharge
*Perianal involvement often a/w vulvovaginal and penile lesions
**Unlike nonvenereal cryptitis, infection is not confined to the posterior crypt
*Refer to specialist for laser ablation or cryotherapy
*[[Special:MyLanguage/Chlamydia|Chlamydia]]
===Gonorrhea===
**Infection due to direct anorectal infection or via vaginal seeding to perirectal lymphatics
*Symptoms vary from none to severe rectal pain w/ yellow, bloody discharge
**Symptoms range from asymptomatic to anal pruritus, pain, purulent discharge
*Unlike nonvenereal cryptitis, infection is not confined to the posterior crypt
**Lymphogranulomatous variety
*Diagnosis made by Gram stain and culture
***Acutely painful anal ulcerations associated with unilateral lymph node enlargement
*Also consider dissemination to heart, liver, CNS, and joints
***[[Special:MyLanguage/Fever|Fever]] and flulike symptoms
*Treatment: CTX 125mg IM + azithromycin 2gm PO single dose
***May result in rectal scarring, stricturing, perirectal abscesses, chronic fistulas
===Chlamydia===
*[[Special:MyLanguage/Syphilis|Syphilis]]
*Infection d/t direct anorectal infection or via vaginal seeding to perirectal lymphatics
**Primary
*Symptoms range from asymptomatic to anal pruritus, pain, purulent discharge
***Anal chancres appear ~2-6 weeks after intercourse, are often painful
*Lymphogranulomatous variety
****May be misdiagnosed as simple fissure
**Acutely painful anal ulcerations a/w unilateral lymph node enlargement
*****Symmetric lesion on opposite side of anal margin is distinguishing feature
**Fever and flulike symptoms
*****Inguinal adenopathy is often present
**May result in rectal scarring, stricturing, perirectal abscesses, chronic fistulas
**Secondary
*Treatment
***Condylomata lata (flatter and firmer than condylomata acuminata)
**Non-LGV: Azithromycin 2gm PO x1 or doxycycline 100mg PO BID x7d
*[[Special:MyLanguage/Herpes Simplex Virus-2|Herpes Simplex Virus-2]]
**LGV: Doxycyline 100mg PO BID x21d
**Itching and soreness in perianal area progressing to severe anorectal pain
===Syphilis===
***Accompanied by flulike illness, inguinal adenopathy
*Primary
**Early lesions are small, discrete vesicles on erythematous base
**Anal chancres are often painful
***Vesicles then enlarge, coalesce, and rupture, forming exquisitely tender ulcers
***May be misdiagnosed as simple fissure
 
****Symmetric lesion on opposite side of anal margin is distinguishing feature
 
****Inguinal adenopathy is often present
==Differential Diagnosis==
*Secondary
 
**Condylomata lata (flatter and firmer than condylomata acuminata)
</translate>
*Treatment
{{Anorectal DDX}}
**Penicillin G 2.4mil IM x1
<translate>
===Herpes===
 
*Itching and soreness in perianal area progressing to severe anorectal pain
 
**Accompanied by flulike illness, inguinal adenopathy
==Evaluation==
*Early lesions are small, discrete vesicles on erythematous base
 
**Vesicles then enlarge, coalesce, and rupture, forming exquisitely tender ulcers
*Consider Gram stain and culture
*Treatment
 
**Acyclovir 400mg PO TID x10d for initial episode; 800mg TID x2d for recurrent episodes
 
==Management==
 
</translate>
{{Presumed GC chlamydia of cervix, urethra, or rectum}}
<translate>
 
 
===[[Special:MyLanguage/Syphilis|Syphilis]]===
 
*[[Special:MyLanguage/Penicillin|Penicillin]] G 2.4mil IM x1
 
 
===[[Special:MyLanguage/Herpes Simplex Virus-2|Herpes Simplex Virus-2]]===
 
*[[Special:MyLanguage/Acyclovir|Acyclovir]] 400mg PO TID x10d for initial episode; 800mg TID x2d for recurrent episodes
 
 
===[[Special:MyLanguage/Lymphogranuloma Venereum|Lymphogranuloma Venereum]]===
 
*Consider in patients with bloody discharge, perianal or mucosal ulcers, chlamydia NAAT+, and MSM
*Extend [[Special:MyLanguage/doxycycline|doxycycline]] 100mg PO BID for 21 days total<ref>Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021;70(No. RR-4):1–187. DOI: http://dx.doi.org/10.15585/mmwr.rr7004a1</ref>
 
 
==Disposition==
 


==See Also==
==See Also==
*[[Anorectal Disorders]]


==Source==
*[[Special:MyLanguage/Anorectal Disorders|Anorectal Disorders]]
Tintinalli
 
 
==External Links==
 
 
==References==


<references/>
[[Category:GI]]
[[Category:GI]]
</translate>

Latest revision as of 23:54, 4 January 2026


Background

Causes

  • Radiation treatment
  • Autoimmune
  • Vasculitis
  • Ischemia
  • Infectious (STI and enteric organisms)


Clinical Features

General

  • Inflammation of the rectal mucosa
  • Pain on defecation
  • Tenesmus
  • Mucoid discharge
  • Inguinal lymphadenopathy (may be seen with T. pallidum)


By Causative Agent

  • Condyloma Acuminata
  • Gonorrhea
    • Symptoms vary from none to severe rectal pain with yellow, bloody discharge
    • Unlike nonvenereal cryptitis, infection is not confined to the posterior crypt
  • Chlamydia
    • Infection due to direct anorectal infection or via vaginal seeding to perirectal lymphatics
    • Symptoms range from asymptomatic to anal pruritus, pain, purulent discharge
    • Lymphogranulomatous variety
      • Acutely painful anal ulcerations associated with unilateral lymph node enlargement
      • Fever and flulike symptoms
      • May result in rectal scarring, stricturing, perirectal abscesses, chronic fistulas
  • Syphilis
    • Primary
      • Anal chancres appear ~2-6 weeks after intercourse, are often painful
        • May be misdiagnosed as simple fissure
          • Symmetric lesion on opposite side of anal margin is distinguishing feature
          • Inguinal adenopathy is often present
    • Secondary
      • Condylomata lata (flatter and firmer than condylomata acuminata)
  • Herpes Simplex Virus-2
    • Itching and soreness in perianal area progressing to severe anorectal pain
      • Accompanied by flulike illness, inguinal adenopathy
    • Early lesions are small, discrete vesicles on erythematous base
      • Vesicles then enlarge, coalesce, and rupture, forming exquisitely tender ulcers


Differential Diagnosis

Anorectal Disorders

Non-GI Look-a-Likes


Evaluation

  • Consider Gram stain and culture


Management

Presumed GC/chlamydia of cervix, urethra, or rectum (uncomplicated)[1]

Typically, treatment for both gonorrhea and chlamydia is indicated, if one entity is suspected.

Standard

  • Gonorrhea
    • Ceftriaxone IM x 1
      • 500 mg, if weight <150 kg
      • 1 g, if weight ≥150 kg
  • Chlamydia


Ceftriaxone contraindicated

^Additional chlamydia coverage only needed if treated with cefixime only

Partner Treatment


Syphilis


Herpes Simplex Virus-2

  • Acyclovir 400mg PO TID x10d for initial episode; 800mg TID x2d for recurrent episodes


Lymphogranuloma Venereum

  • Consider in patients with bloody discharge, perianal or mucosal ulcers, chlamydia NAAT+, and MSM
  • Extend doxycycline 100mg PO BID for 21 days total[2]


Disposition

See Also


External Links

References

  1. ↑ Cyr SS et al. Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR. Center for Disease Control and Prevention. 2020. 69(50):1911-1916
  2. ↑ Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021;70(No. RR-4):1–187. DOI: http://dx.doi.org/10.15585/mmwr.rr7004a1
Retrieved from "https://www.wikem.org/w/index.php?title=Proctitis&oldid=379063"