We report the case of a year-old male who was initially assessed for pain with defecation, bloody rectal discharge, and diarrhea, consistent with proctitis. Though proctitis is most commonly due to inflammatory bowel disease IBDinfectious etiologies must also be considered, including sexually transmitted causes of infectious proctitis.Time complexity in data structure
In discussion of his sexual history, he identified as homosexual and acknowledged engaging in receptive anal intercourse. Rectal biopsies obtained via colonoscopy were culture-positive for herpes simplex virus HSVleading to a diagnosis of HSV proctitis and treatment with an appropriate antiviral medication. HSV proctitis is more common in individuals with high-risk sexual practices, including men who have sex with men.
While this may be an uncommon diagnosis for pediatricians to make in practice, a high clinical index of suspicion for sexually transmitted infectious proctitis in those with risk factors must be maintained in order to facilitate appropriate testing, treatment, and counseling of affected individuals.
Sexually Transmitted Proctitis
A year-old male was admitted to the hospital after presenting with 6 days of rectal bleeding, diarrhea, purulent rectal drainage, and tenesmus. He complained of bloody and mucoid stools. He did not have rectal bleeding prior to this illness. He reported no skin lesions of his genital or anal areas.
He had not been eating or drinking well during the course of this illness due to lack of appetite. He denied any abdominal pain, fevers, night sweats, oral lesions, or arthralgia. On the evening prior to admission, he developed an erythematous, pruritic, slightly raised rash without vesicles or central clearing on his trunk that spread to his buttocks and legs. He described intermittent blurry vision that started at about the same time as his stool changes, without any eye pain.
Past medical history included one episode of candidal esophagitis that was successfully treated with fluconazole. He was noted to have mild lymphopenia at that time, and for which he underwent an extensive work-up for immunodeficiency, including a normal complete blood count CBC with differential, a normal peripheral blood smear, and negative human immunodeficiency virus HIV antibodies. Flow cytometry showed minimally decreased absolute numbers of total T-cells, CD4 T-cells, and CD8 T-cells and was deemed unlikely to result in increased susceptibility to infections by an immunologist.
Family history was significant for ulcerative colitis in his maternal grandmother. Social history was significant for oral and receptive anal intercourse on multiple occasions, with last sexual encounter within the past month. Condom use was inconsistent. He denied knowledge of his partner having any sexually transmitted infections.
He denied personal history of sexually transmitted infections or sexual abuse. Upon admission, physical exam showed an alert and cooperative teenaged male with vital signs remarkable for mild tachycardia. Skin exam showed a pruritic morbilliform rash on the neck, upper extremities, trunk, buttocks, and lower extremities with dermatographism.
Petechiae were noted on the palate. Genitourinary exam showed Tanner V genitalia without urethral discharge. No perianal or genitourinary cutaneous lesions were present. Cardiopulmonary, abdominal, neurological, and funduscopic examinations were all normal.
CBC with differential was normal and without previously described lymphopenia.Sexually transmitted gastrointestinal syndromes include proctitis, proctocolitis, and enteritis.
Herpes simplex virus
Evaluation for these syndromes should include appropriate diagnostic procedures e. Proctitis is inflammation of the rectum i. In persons with HIV infection, herpes proctitis can be especially severe. Proctitis occurs predominantly among persons who participate in receptive anal intercourse. Proctocolitis is associated with symptoms of proctitis, diarrhea or abdominal cramps, and inflammation of the colonic mucosa extending to 12 cm above the anus.
Fecal leukocytes might be detected on stool examination, depending on the pathogen. Pathogenic organisms include Campylobacter sp. Proctocolitis can be acquired through receptive anal intercourse or by oral-anal contact, depending on the pathogen.
Enteritis usually results in diarrhea and abdominal cramping without signs of proctitis or proctocolitis; it occurs among persons whose sexual practices include oral-anal contact. In otherwise healthy persons, Giardia lamblia is most frequently implicated. When outbreaks of gastrointestinal illness occur among social or sexual networks of MSM, clinicians should consider sexual transmission as a mode of spread and provide counseling accordingly. Among persons with HIV infection, enteritis can be caused by pathogens that may not be sexually transmitted, including CMV, Mycobacterium avium — intracellulareSalmonella sp.
Multiple stool examinations might be necessary to detect Giardiaand special stool preparations are required to diagnose cryptosporidiosis and microsporidiosis. In addition, enteritis can be directly caused by HIV infection. Diagnostic and treatment recommendations for all enteric infections are beyond the scope of these guidelines. Persons who present with symptoms of acute proctitis should be examined by anoscopy.
A Gram-stained smear of any anorectal exudate from anoscopic or anal examination should be examined for polymorphonuclear leukocytes. If the C.
Herpes Simplex Virus Proctitis Masquerading as Rectal Cancer
Acute proctitis of recent onset among persons who have recently practiced receptive anal intercourse is usually sexually acquiredPresumptive therapy should be initiated while awaiting results of laboratory tests for persons with anorectal exudate detected on examination or polymorphonuclear leukocytes detected on a Gram-stained smear of anorectal exudate or secretions; such therapy also should be initiated when anoscopy or Gram stain is unavailable and the clinical presentation is consistent with acute proctitis in persons reporting receptive anal intercourse.
If painful perianal ulcers are present or mucosal ulcers are detected on anoscopy, presumptive therapy should also include a regimen for genital herpes see Genital HSV Infections. To minimize transmission and reinfection, men treated for acute proctitis should be instructed to abstain from sexual intercourse until they and their partner s have been adequately treated i.
All persons with acute proctitis should be tested for HIV and syphilis. Follow-up should be based on specific etiology and severity of clinical symptoms. For proctitis associated with gonorrhea or chlamydia, retesting for the respective pathogen should be performed 3 months after treatment. Partners who have had sexual contact with persons treated for GC, CT, or LGV within the 60 days before the onset of the persons symptoms should be evaluated, tested, and presumptively treated for the respective pathogen.
Partners of persons with sexually transmitted enteric infections should be evaluated for any diseases diagnosed in the person with acute proctitis. Sex partners should abstain from sexual intercourse until they and their partner with acute proctitis are adequately treated. Allergic reactions with third-generation cephalosporins e. In those persons with a history of an IgE mediated penicillin allergy e. Persons with HIV infection and acute proctitis may present with bloody discharge, painful perianal ulcers, or mucosal ulcers.There are many different sexually transmitted infections that can cause proctitis.
Recognition of the common symptoms with anoscopic examination is crucial in accurate diagnosis of the pathogen. Clinicians should have a high index of suspicion of more than one inciting pathogen. Treatment should be prompt and extended to sexual partners who have been exposed to the disease. Effective treatment can alleviate the discomfort and potentially serious complications associated with sexually transmitted proctitides.
This article illustrates and discusses the clinical presentations, diagnostic pearls, and treatments of sexually transmitted proctitides. Sexually acquired proctitis with inflammation of the rectal mucosa the distal 15 cm results from direct rectal inoculation of pathogens.
Acute proctitis in persons who have practiced receptive anorectal intercourse is usually sexually acquired. However, the diagnosis cannot be definitively ruled out in patients who do not report a history of anal intercourse.
A thorough history and physical examination can alert the physician to the possibility of a sexually transmitted infection. Chlamydia, gonorrhea, herpes simplex virus HSVand syphilis are among the most common causes of sexually transmitted proctitis. Recently, sexually transmitted infections STIs from lymphogranuloma venereum LGV have been reported in men who have sex with men MSM and the diagnosis and treatment are being reviewed.
Opportunistic infections from cytomegalovirus CMV may cause ulcerative anorectal lesions in this population.Y8 games 1 player
This review examines the causative organisms, clinical features, diagnosis, and treatment of sexually transmitted proctitides. Gonorrhea is the second most commonly reported sexually transmitted bacterial infection in the United States.
It is a disease of the young, sexually active patient. Gonorrhea rates decreased further to This is the lowest published rate since the recording of gonorrhea rates began.
Sincethe gonorrhea rate has increased slightly each year to This translates tocases of gonorrhea being reported in the United States in Visit the online store for some effective treatments to get your outbreaks under control, click here for more. Proctitis is an inflammation of the rectum. Proctitis causes discomfort eliminating, rectal bleeding, and occasionally, a rectal discharge of mucus or pus.
Proctitis symptoms can be short-lived, or they may become chronic. Ulcerative colitis is a chronic inflammation of the large intestine colon. Ulcerative colitis limited to the rectum is called ulcerative proctitis.
Non-sexually transmitted infections Non-sexually transmitted infections caused by the same bacteria that causes strep throat occurring in children.
Medications and radiation therapy for cancer Proctitis and HSV-2 in gay men HSV-2 infection of the anal area is a frequent cause of proctitis in gay men. The relative frequency of HSV proctitis in gay men corresponds to the high incidence of anal intercourse in this population. John Hopkins HospitalWatch the Video.
Do you also think you may have been exposed to another STD? Find help now. Herpes Proctitis Can you have herpes rectally? Take action and take back control Visit the online store for some effective treatments to get your outbreaks under control, click here for more. Doctors Answers Dr. Amy Dr. Erica Dr. Rob Dr. All rights reserved.Proctitis is inflammation of the lining of the rectum. The rectum is a muscular tube that's connected to the end of your colon.
Stool passes through the rectum on its way out of the body.Herpes Simplex - Infectious Diseases Medicine Lecture - Medical V-Learning - vinavyozusb.pw
Proctitis can cause rectal pain, diarrhea, bleeding and discharge, as well as the continuous feeling that you need to have a bowel movement. Proctitis symptoms can be short-lived, or they can become chronic. Proctitis is common in people who have inflammatory bowel disease Crohn's disease or ulcerative colitis. Sexually transmitted infections are another frequent cause. Proctitis also can be a side effect of radiation therapy for certain cancers.
Proctitis that isn't treated or that doesn't respond to treatment may lead to complications, including:. To reduce your risk of proctitis, take steps to protect yourself from sexually transmitted infections STIs. The surest way to prevent an STI is to abstain from sex, especially anal sex. If you choose to have sex, reduce your risk of an STI by:. If you're diagnosed with a sexually transmitted infection, stop having sex until after you've completed treatment.
Ask your doctor when it's safe to have sex again. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Overview Proctitis is inflammation of the lining of the rectum. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Proctitis.However, no cases of rectal masses secondary to HSV infection have been reported to date.
Herein, we present the case of a year-old man with HIV infection who developed rectal pain and bleeding, along with dysuria and voiding difficulty. Colonoscopy revealed proctitis and a rectal mass with features concerning for rectal cancer.
Histologic sections of the rectal mass biopsy demonstrated colorectal mucosa with viral cytopathic changes, ulceration, granulation tissue, marked inflammatory infiltrate, and fibrinopurulent exudate. Immunohistochemistry for herpes simplex virus-1 was positive in epithelial cells demonstrating a viral cytopathic effect. The patient was treated with valacyclovir for 3 weeks, which led to complete resolution of his symptoms.
Follow-up sigmoidoscopy at 6 months did not show any masses. Our case illustrates the importance of considering HSV in the differential diagnosis of rectal masses. We advocate the routine use of viral immunohistochemistry for the evaluation of rectal tumors, especially in patients with clinical manifestations and endoscopic findings consistent with proctitis. A year-old man presented to the hospital with complaints of rectal pain and bright red blood with each bowel movement for the past 6 months.
He also described cramping rectal pain alleviated by bowel movements and aggravated by sitting and straining. He denied fevers or chills, but endorsed pound weight loss in the last 3 weeks due to anorexia and fear of having a painful bowel movement. He admitted to have receptive anal intercourse, but had not been sexually active for the past 14 months due to pain.
He also complained of dysuria and straining to urinate with incomplete voiding.
The patient had a history of HIV infection and treated syphilis 6 months ago. A physical exam revealed a soft, nontender, and nondistended abdomen with normal bowel sounds.
A rectal exam showed normal rectal tone, tenderness to palpation, external hemorrhoids, and a deep anal fissure.Used ducati parts
Laboratory studies were significant for hemoglobin of Urinalysis was normal. Computed tomography revealed prominent concentric thickening of the mid and lower rectum with associated mesorectal fat stranding and lymphadenopathy, highly concerning for an underlying rectal neoplasm or severe proctocolitis.
For this reason, the patient underwent a colonoscopy that showed a fungating and infiltrative partially obstructing medium-sized mass in the rectum, 10—15 cm from the anal verge Figure 1 A.
Discontinuous areas of nonbleeding ulcerated mucosa with no stigmata of recent bleeding were present in the rectum. Multiple biopsies were obtained. He was started empirically on doxycycline mg every 12 hours for possible lymphogranuloma venereum or syphilis.
RPR rapid plasma reagin titer was ; however, the patient had a titer of 6 months ago, consistent with history of adequately treated syphilis.A common symptom is a continual urge to have a bowel movement—the rectum could feel full or have constipation. Another is tenderness and mild irritation in the rectum and anal region. A serious symptom is pus and blood in the dischargeaccompanied by cramps and pain during the bowel movement.
If there is severe bleeding, anemia can result, showing symptoms such as pale skin, irritability, weakness, dizziness, brittle nails, and shortness of breath. Symptoms are ineffectual straining to empty the bowels, diarrhearectal bleeding and possible discharge, a feeling of not having adequately emptied the bowels, involuntary spasms and cramping during bowel movements, left-sided abdominal pain, passage of mucus through the rectum, and anorectal pain.
Gonorrhea Gonococcal proctitis. Chlamydia chlamydia proctitis. Herpes Simplex Virus 1 and 2 herpes proctitis. Syphilis syphilitic proctitis. Proctitis has many possible causes.
It may occur idiopathically idiopathic proctitis, that is, arising spontaneously or from an unknown cause. Other causes include damage by irradiation for example in radiation therapy for cervical cancer and prostate cancer or as a sexually transmitted infectionas in lymphogranuloma venereum and herpes proctitis.
Studies suggest a celiac disease-associated "proctitis" can result from an intolerance to gluten. A common cause is engaging in anal sex with partner s infected with sexual transmitted diseases in men who have sex with men. Doctors can diagnose proctitis by looking inside the rectum with a proctoscope or a sigmoidoscope. A biopsy is taken, in which the doctor scrapes a tiny piece of tissue from the rectum, and this tissue is then examined by microscopy.
The physician may also take a stool sample to test for infections or bacteria. If the physician suspects that the patient has Crohn's disease or ulcerative colitis, colonoscopy or barium enema X-rays are used to examine areas of the intestine.
Treatment for proctitis varies depending on severity and the cause. For example, the physician may prescribe antibiotics for proctitis caused by bacterial infection.
If the proctitis is caused by Crohn's disease or ulcerative colitis, the physician may prescribe the drug 5-aminosalicyclic acid 5ASA or corticosteroids applied directly to the area in enema or suppository form, or taken orally in pill form. Enema and suppository applications are usually more effective, but some patients may require a combination of oral and rectal applications. Another treatment available is that of fiber supplements such as Metamucil.
Taken daily these may restore regularity and reduce pain associated with proctitis. Chronic radiation proctitis is usually treated first-line with sucralfate enemas. These are non-invasive and are effective in diffuse, distal disease. Other treatments may include mesalamine suppositories, vitamin E, hyperbaric oxygen, or short chain fatty acid enemas; however these treatments are only supported by observational or anecdotal evidence.
From Wikipedia, the free encyclopedia. Main article: Radiation proctitis. Methods Mol Med.Cpytoimpf
Quantitative histological and immunocytochemical studies of rectal mucosae in gluten sensitivity". Clinical Infectious Diseases. Sex Transm Dis. ICD - 10 : K Diseases of the digestive system primarily K20—K93— Proctitis Radiation proctitis Proctalgia fugax Rectal prolapse Anismus.
Proctitis, Proctocolitis, and Enteritis
Upper Hematemesis Melena Lower Hematochezia. Peritonitis Spontaneous bacterial peritonitis Hemoperitoneum Pneumoperitoneum. See templates for discussion to help reach a consensus.
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