Differential Diagnosis for Infectious Proctitis
Single Most Likely Diagnosis
- Gonococcal proctitis: This is the most likely diagnosis due to the high prevalence of Neisseria gonorrhoeae infections, especially in individuals with high-risk sexual behavior. Gonococcal proctitis typically presents with symptoms such as rectal pain, discharge, and bleeding.
Other Likely Diagnoses
- Chlamydial proctitis: Similar to gonococcal proctitis, Chlamydia trachomatis is a common cause of infectious proctitis, particularly in individuals with multiple sexual partners or those who practice receptive anal intercourse.
- Herpes simplex proctitis: This diagnosis is likely in individuals with a history of herpes simplex virus (HSV) infection, as HSV can cause proctitis characterized by painful rectal ulcers and discharge.
- Syphilitic proctitis: This diagnosis should be considered in individuals with a history of syphilis or those who have had sexual contact with someone infected with Treponema pallidum.
Do Not Miss Diagnoses
- Amoebic proctitis: Although less common, amoebic proctitis caused by Entamoeba histolytica can be life-threatening if left untreated, especially in immunocompromised individuals. It is essential to consider this diagnosis in individuals with a history of travel to endemic areas or those with exposure to contaminated water.
- CMV proctitis: Cytomegavirus (CMV) proctitis is a potentially life-threatening condition that can occur in immunocompromised individuals, such as those with HIV/AIDS or organ transplant recipients. Early recognition and treatment are crucial to prevent severe complications.
Rare Diagnoses
- Lymphogranuloma venereum (LGV) proctitis: This rare diagnosis is caused by specific serovars of Chlamydia trachomatis and can present with symptoms such as rectal pain, discharge, and bleeding. LGV proctitis is more common in individuals with high-risk sexual behavior.
- Tuberculous proctitis: Although rare, tuberculous proctitis can occur in individuals with pulmonary or extrapulmonary tuberculosis. This diagnosis should be considered in individuals with a history of tuberculosis or those from endemic areas.