Infectious Causes of Proctitis

Sexually Transmitted Infections

The Centers for Disease Control and Prevention recommends that Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, and Herpes simplex virus be considered as primary pathogens in individuals with proctitis who engage in receptive anal intercourse 1, 2
Chlamydia trachomatis, including lymphogranuloma venereum (LGV) serovars, can cause severe proctitis in individuals who engage in receptive anal intercourse 1, 4
Herpes simplex virus can cause severe proctitis, especially in HIV-infected individuals 1, 4

Campylobacter species and Shigella species can cause proctocolitis, particularly in men who have sex with men 1, 2
Entamoeba histolytica and Giardia lamblia can cause proctocolitis in individuals who engage in oral-anal contact 1, 2

Cytomegalovirus can cause severe proctitis in immunosuppressed patients 1, 4
Mycobacterium avium-intracellulare, Cryptosporidium, Microsporidium, and Isospora can cause enteritis in HIV-infected individuals 1, 2

A detailed sexual history is crucial in the diagnosis of proctitis, particularly regarding receptive anal intercourse 5
HIV status should be assessed, as it affects treatment approach and prognosis 5
Anoscopy should be performed to visualize the rectal mucosa, and a Gram-stained smear of anorectal exudate should be examined for polymorphonuclear leukocytes 5, 6
All patients should be tested for HSV, N. gonorrhoeae, C. trachomatis, and T. pallidum 3, 6

HIV testing should be performed in all patients with infectious proctitis, as HIV status affects treatment approach and prognosis 6
Sexual partners should be evaluated and treated to prevent reinfection and further transmission 4, 6
Persistent symptoms after treatment warrant evaluation for reinfection, treatment failure, or alternative diagnoses 5