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Sexually transmitted proctitis, proctocolitis and enteritis
Last reviewed: 23.04.2024
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Sexually transmitted gastrointestinal syndromes include proctitis, proctocolitis and enteritis. Proctitis is observed mainly in individuals practicing anal sex, and enteritis - oral-anal. Depending on the pathogenic microorganism, the protocollitis can develop in any of these ways of infection. The examination should include diagnostic procedures such as an anoscopy or sigmoidoscopy, microscopic and culture examination of feces.
Proctitis is an inflammation limited to the rectum (distal part 10-12 cm), which is accompanied by pain in the anorectal area, tenesmus and secretions from the rectum. N. Gonorrhoeae, C. Trachomatis (including serovars, causing VLG), T. Pallidum and HSV are the most common pathogens. In HIV-infected patients, proctitis caused by HSV can be particularly difficult.
The proctocolitis is associated with symptoms of proctitis, which is associated with diarrhea and / or spasms in the intestine and inflammation of the mucosa of the large intestine at a distance exceeding 12 cm from the anus. Pathogenic microorganisms include Campylobacter spp., Shigella spp., Entamoeba histolytica and rarely C. Trachomatis (serovars that cause HSV). CMV and other opportunistic pathogens can be detected in HIV-infected persons with weakened immunity.
Enteritis is usually accompanied by diarrhea and spasms in the intestines with no signs of proctitis or proctocolitis. In the remaining healthy patients, Giardia lamblia is most often found. Patients with HIV infection can be diagnosed with infections that are not usually transmitted sexually, including Mycobacterium avium-intracellulare, Salmonella spp., Cryptosporidium, Microsporidium and Isospora. Multiple feces can be needed to detect Giardia and special feces examination techniques for the diagnosis of cryptosporidiasis and microsporidiasis. In addition, enteritis may be the first manifestation of HIV infection.
In the presence of diagnostic laboratory equipment, treatment should be carried out in accordance with the diagnosis. Recommendations for the diagnosis and treatment of all intestinal infections are not included in this manual.
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Treatment of proctitis, proctocolitis and enteritis
The cause of acute proctitis, which is diagnosed in people who have recently practiced passive anal sex, is most often a sexually transmitted infection. In such patients, an anoscopy should be performed and an investigation of HSV, N. Gonorrhoeae, C. Trachomatis and T. Pallidum should be performed. If during the examination a secretion of pus from the rectum or in a smear of secretion from the rectum stained by Gram is detected, polymorphonuclear leukocytes are detected, and before the results of laboratory tests can be prescribed, therapy can be prescribed.
Recommended treatment regimen
Ceftriaxone 125 mg IM (or another drug effective against anal and genital gonorrhea)
Plus Doxycycline 100 mg orally 2 times a day for 7 days.
NOTE. For the treatment of patients with herpetic proctitis, see Genital infections caused by the herpes simplex virus.
Follow-up
Follow-up care should depend on the specific etiology and severity of the clinical symptoms. Reinfection is difficult to distinguish from ineffective treatment.
[9], [10], [11], [12], [13], [14],
Management of sexual partners
Partners of patients with intestinal infections acquired through sexual intercourse should be examined for all diseases detected in these patients.
Drugs