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©The Author(s) 2016.
World J Gastroenterol. Jul 14, 2016; 22(26): 5867-5878
Published online Jul 14, 2016. doi: 10.3748/wjg.v22.i26.5867
Published online Jul 14, 2016. doi: 10.3748/wjg.v22.i26.5867
Table 2 Diagnosis and treatment of common infectious organisms causing sexually transmitted proctitis (by the frequency of occurrence)
Disease (causative organism) | Common symptoms and signs | Suggested investigations | Recommended first line treatment |
Chlamydia (Chlamydia trachomatis serovars D-K) | Commonly asymptomatic, mild proctitis, cervicitis, vaginitis, urethritis | Nucleic acid amplification test (NAAT) from rectal, endocervical or urethral swab specimens | Azithromycin 1 g orally in a single dose |
OR | |||
Doxycycline 100 mg orally twice a day for 7 d | |||
Gonorrhea (Neisseria gonorrhoeae) | Lower abdominal pain, diarrhea, rectal bleeding, tenesmus, purulent rectal discharge, urethral discharge and/or pharyngeal infection | Gram stain (Gram-negative diplococci) and bacterial culture from anogential and pharyngeal swab | Ceftriaxone 250 mg IM in a single dose |
PLUS | |||
Azithromycin 1 g orally in a single dose | |||
Herpes simplex virus (Herpes simplex virus) | Painful multiple vesicular or ulcerative lesions at perianal skin and anal canal, painful defecation, fever | Viral culture or polymerase chain reaction (PCR) from vesicular lesions | Acyclovir 400 mg orally three times a day for 7-10 d |
OR | |||
Acyclovir 200 mg orally five times a day for 7-10 d | |||
Syphilis (Treponema pallidum) | Depending on the stage of infection - Primary syphilis: painless ulcers or chancre in the anorectal region | Darkfield examination and test to detect T. pallidum from lesion exudate or tissue | Benzathine penicillin G 2.4 million unit IM in a single dose |
Secondary syphilis: maculopapular rash, condyloma lata, snail-track ulcer and mucous patch at the rectum, lymphadenopathy | OR | ||
Ceftriaxone 1-2 g either IV or IM for 10-14 d | |||
OR | |||
Doxycycline 100 mg orally twice a day for 14 d | |||
Lymphogranuloma venereum (Chlamydia trachomatis serovars L1, L2 and L3) | Anal pain, mucous or bloody rectal discharge, anorectal ulcer, fever, inguinal or femoral lymphadenopathy | Culture, direct immunofluorescence or nucleic acid detection form rectal lesion and lymph node specimen | Doxycycline 100 mg orally twice a day for 21 d |
OR | |||
Erythromycin base 500 mg oral four times a day for 21 d |
- Citation: Lohsiriwat V. Anorectal emergencies. World J Gastroenterol 2016; 22(26): 5867-5878
- URL: https://www.wjgnet.com/1007-9327/full/v22/i26/5867.htm
- DOI: https://dx.doi.org/10.3748/wjg.v22.i26.5867