Treatment of Proctitis

Diagnostic Approach

The Centers for Disease Control and Prevention recommends that patients presenting with symptoms of acute proctitis should undergo anoscopy examination 1, 2
A Gram-stained smear of anorectal exudate should be examined for polymorphonuclear leukocytes 1
All patients should be evaluated for N. gonorrhoeae (NAAT or culture) 1
If C. trachomatis test is positive on a rectal swab, a molecular PCR test for LGV should be performed to confirm LGV diagnosis 1

The Centers for Disease Control and Prevention recommends initiating treatment with ceftriaxone 250 mg IM in a single dose PLUS doxycycline 100 mg orally twice a day for 7 days for patients with acute proctitis 1, 2
For patients with bloody discharge, perianal ulcers, or mucosal ulcers, extended treatment for LGV with doxycycline 100 mg twice daily orally for a total of 3 weeks should be provided 1, 2

Patients should abstain from sexual intercourse until they and their partner(s) have been adequately treated (completion of 7-day regimen and resolution of symptoms) 1
All persons with acute proctitis should be tested for HIV and syphilis 1
For proctitis associated with gonorrhea or chlamydia, retesting for the respective pathogen should be performed 3 months after treatment 1, 3

Partners who had sexual contact with persons treated for gonorrhea, chlamydia, or LGV within 60 days before symptom onset should be evaluated, tested, and treated presumptively 1, 3

The most common sexually transmitted pathogens causing proctitis are N. gonorrhoeae, C. trachomatis (including LGV serovars), T. pallidum, and HSV 2
In persons with HIV infection, herpes proctitis can be especially severe and may require closer monitoring 2, 3