Name
PROCTITIS
DESCRIPTION
DETAIL
CAUSES β’ Idiopathic β’ Rectal gonorrhea β’ Crohn disease β’ Syphilis (usually secondary) β’ Nonspecifi c sexually transmitted infection β’ Herpes simplex β’ Chlamydia β’ Papillomavirus β’ Amebiasis β’ Lymphogranuloma venereum β’ Ischemia β’ Radiation therapy β’ Toxins (e.g., hydrogen peroxide enemas) β’ Vasculitis -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ Traumatic proctitis β’ Radiation proctitis β’ Ulcerative colitis β’ Crohn disease β’ Infections such as shigellosis or amebiasisOTHER TESTS : * PUS SMEAR TEST FROM ANAL CANAL FOR GONORRHEA, HERPES SIMPLEX VIRUS, C. TRICHOMATIS & T. PALLIDUM β’ Serological tests for syphilis, ameba β’ Stool cultures DIAGNOSTIC PROCEDURES β’ Flexible sigmoidoscopy β’ Biopsy for histology, culture, viral studies, chlamydia culture β’ Colonoscopy to exclude more proximal involvement
TYPENOTES
RISK FACTORS: Rectal intercourse, Radiation, Rectal injury, Rectal medications, Jewish heritageGENERAL MEASURES β’ Treatment depends upon the cause β’ Rectal gram stains have signifi cant false-negative rate and if clinician has strong suspicion of gonorrheal proctitis, empiric treatment warranted while culture results pending β’ Avoidance of causative factors β’ Sitz baths may provide some relief DRUG(S) OF CHOICE β’ Ulcerative proctitis - topical steroids (enemas or foam), mesalamine (Rowasa, 5-ASA, 5-aminosalicylic acid) enemas or suppositories; oral mesalamine (Asacol, Pentasa), olsalazine (Dipentum), sulfasalazine; systemic steroids when refractory to above drugs β’ Gonorrheal - IM ceftriaxone 250 mg in a single dose plus doxycycline 100 mg orally bid for 7 days β’ Herpetic - oral acyclovir 200-400 mg 5 times a day for 10 days β’ Chlamydial - oral tetracycline 500 mg tid or doxycycline 100 mg bid ALTERNATIVE DRUGS For gonorrheal - in patients unable to take ceftriaxone - IM spectinomycin 2 g in a single dose or ciprofloxacin 500 mg orally in a single dose. Perform culture 4-7 days after treatment to verify effi cacy of treatment. PATIENT MONITORING Follow until completely healed and monthly thereafter for 6 months PREVENTION/AVOIDANCE Safe sex, if sexually transmitted POSSIBLE COMPLICATIONS β’ Chronic ulcerative colitis β’ Fistulae/abscess formation β’ Treatment failure (may be as much as 35% in gonorrhea proctitis) β’ Perforation EXPECTED COURSE/PROGNOSIS Satisfactory cure or control with appropriate treatment
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
VDRL, HIV I & II, COMPLETE BLOOD COUNT, PUS CULTURE TEST
[PROCTITIS]