From the Guidelines
Infectious proctitis can be identified through a combination of symptoms, physical examination, and diagnostic tests, with the most recent guidelines suggesting a focused medical history, complete physical examination, and diagnostic tests such as rectal swabs and stool cultures 1. The diagnostic criteria for infectious proctitis include:
- Symptoms: rectal pain, discharge, bleeding, tenesmus, and sometimes fever
- Physical examination: rectal tenderness, discharge, or mucosal inflammation
- Diagnostic tests:
- Rectal swabs for gonorrhea and chlamydia
- Stool cultures for pathogens like Shigella or Campylobacter
- Sigmoidoscopy or colonoscopy with biopsies in some cases According to the most recent study 1, imaging modalities such as MRI, CT scan, or endosonography may be used for the initial evaluation of an anorectal complaint, especially in cases of suspected perianal disease, rectal fistula, or proctitis. The diagnosis of infectious proctitis should be based on a combination of clinical presentation, physical examination, and diagnostic tests, with a focus on identifying the causative organism to guide treatment 1. Treatment depends on the causative organism, and prompt treatment is essential to prevent complications such as strictures, fistulas, or systemic spread of infection. Some key treatment options include:
- Gonorrhea: single dose of ceftriaxone 500mg intramuscularly, often combined with doxycycline 100mg twice daily for 7 days
- Herpes proctitis: acyclovir 400mg three times daily for 7-10 days
- Syphilis: benzathine penicillin G 2.4 million units intramuscularly as a single dose
- Bacterial infections like Shigella: ciprofloxacin 500mg twice daily for 3-7 days It is also important to evaluate and treat sexual partners to prevent reinfection, and patients should abstain from sexual activity until treatment is complete 1.