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Sexually transmitted proctitis, proctocolitis and enteritis
Last reviewed: 07.07.2025
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Sexually transmitted gastrointestinal syndromes include proctitis, proctocolitis, and enteritis. Proctitis occurs primarily in individuals who engage in anal intercourse, and enteritis occurs primarily in those who engage in oral-anal intercourse. Depending on the pathogen, proctocolitis may occur with any of these routes of infection. Evaluation should include diagnostic procedures such as anoscopy or sigmoidoscopy, microscopic examination, and fecal culture.
Proctitis is an inflammation limited to the rectum (distal 10-12 cm), which is accompanied by anorectal pain, tenesmus, and rectal discharge. N. gonorrhoeae, C. trachomatis (including serovars causing LGV), T. pallidum, and HSV are the most common pathogens. In HIV-infected patients, proctitis caused by HSV may be particularly severe.
Proctocolitis is associated with symptoms of proctitis, which include diarrhea and/or intestinal cramps and inflammation of the colonic mucosa 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 may be detected in immunocompromised HIV-infected individuals.
Enteritis typically involves diarrhea and intestinal cramping without evidence of proctitis or proctocolitis. In otherwise healthy patients, Giardia lamblia is the most common bacterium. Patients with HIV infection may have infections that are not typically sexually transmitted, including Mycobacterium avium-intracellulare, Salmonella spp., Cryptosporidium, Microsporidium, and Isospora. Multiple stool tests may be needed to detect Giardia and specialized stool tests to diagnose cryptosporidiasis and microsporidiasis. In addition, enteritis may be the first manifestation of HIV infection.
If diagnostic laboratory equipment is available, 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 guide.
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Treatment of proctitis, proctocolitis and enteritis
Acute proctitis diagnosed in individuals who have recently engaged in passive anal sex is most often caused by a sexually transmitted infection. Such patients should undergo anoscopy and be tested for HSV, N. gonorrhoeae, C. trachomatis, and T. pallidum. If the examination reveals pus from the rectum or if polymorphonuclear leukocytes are detected in a Gram-stained smear of rectal discharge, therapy may be prescribed pending laboratory test results.
Recommended treatment regimen
Ceftriaxone 125 mg IM (or other drug effective against anal and genital gonorrhea)
Plus Doxycycline 100 mg orally 2 times a day for 7 days.
NOTE: For treatment of patients with herpetic proctitis, see Genital Herpes Simplex Virus Infections.
Follow-up observation
Follow-up should depend on the specific etiology and severity of clinical symptoms. Reinfection is difficult to differentiate from treatment failure.
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Management of sexual partners
Partners of patients with sexually acquired intestinal infections should be examined for all diseases detected in these patients.
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