Gonococcal proctitis is usually acquired sexually and is most commonly seen in individuals who practice receptive anal intercourse. Proctitis alone may not produce systemic symptoms such as fever. Moreover, a large proportion of those affected are asymptomatic [1]. Symptomatic infection may present as gastrointestinal complaints that include tenesmus, diarrhea, lower abdominal pain in the left quadrant, and stool withholding behavior due to pain during defecation. A mucopurulent rectal discharge, rectal bleeding, and less commonly anal pain and itching may also be described. These clinical manifestations often appear a few days after anal intercourse without the use of a barrier protective method, and the disease course may either be acute or chronic. Furthermore, the presence of pharyngeal and genital gonococcal invasion may indicate the possibility of rectal infection [2]. This is particularly useful as some signs which are seen with gonococcal proctitis may be identical to those found in other inflammatory bowel conditions.

Visualization of the rectal mucosa through proctoscopy may reveal normal or inflamed mucosa, and in some cases, abscesses. Lesions do not normally extend past the dentate line to the anus, but those that do are more likely to produce symptoms.

• Unsafe Sexual Practices

  sexual practices) Having a partner who is an IV drug user Bisexual or homosexual partners Anal intercourse ( Anal sex with a condom decreases the risk of proctitis by STDs, but you can still get proctitis from anal trauma) Having unprotected intercourse [webmd.com]

  sexual practices) Having a partner who is an IV drug user Bisexual or homosexual partners Anal intercourse (Anal sex with a condom decreases the risk of proctitis by STDs, but you can still get proctitis from anal trauma.) [emedicinehealth.com]

  sexual practices) Having a partner who is an IV drug user Bisexual or homosexual partners Anal intercourse (Anal sex with a condom decreases the risk of proctitis by STDs, but you can still get proctitis from anal trauma) Having unprotected intercourse [tipdisease.com]

  The predisposing factors for urethritis are multiple sexual partners, unsafe sexual practices, a current sexually transmitted infection (STI), and recent urethral instrumentation. [infectiousdiseaseadvisor.com]

• Malaise

  On further questioning he also complained of malaise, myalgia and arthralgia. He admitted to unprotected receptive anal sexual intercourse with two male partners in the preceding 6 months. [fg.bmj.com]

  Fever and malaise commonly accompany local symptoms. The primary genital ulcer often resolves before or during this stage, but proctitis is likely to persist. [ecdc.europa.eu]

• Constitutional Symptom

  Lymphogranuloma venereum is commonly seen with certain serotypes of C. trachomatis and is often asymptomatic or associated with constitutional symptoms but can lead to strictures and fistulae. [infectiousdiseaseadvisor.com]

• Tenesmus

  Symptomatic infection may present as gastrointestinal complaints that include tenesmus, diarrhea, lower abdominal pain in the left quadrant, and stool withholding behavior due to pain during defecation. [symptoma.com]

  Ulcerations are usually accompanied by rectal bleeding, straining of rectal muscles (tenesmus) and an anal discharge of bloody mucus. However, anal bleeding is seldom severe. [rarediseases.org]

  Symptoms of Proctitis Painful, frequent bowel movements Straining at stool (tenesmus) Hematochezia Rectal pain or bleeding, itching, and cramps Bloody, pus- or mucus-filled discharge Constipation or diarrhea Fever Blisters or open sores in or around the [healthcommunities.com]

  LGV proctitis can be asymptomatic, mucoid and/or hemorrhagic rectal discharge, anal pain, constipation, fever, and/or tenesmus. Chronic proctitis presents with rectal bleeding, diarrhea, urgency, tenesmus, incontinence, or pelvic pain. [statpearls.com]

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• Suggestibility

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  The following recommendations apply only to men and women presenting with symptoms suggestive of sexually transmitted proctitis and not children. [canada.ca]

  Perianal and rectal examination revealed two fluctuant, tender areas of induration adjacent to the anal verge suggestive of abscesses. [fg.bmj.com]

• Sexual Dysfunction

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• Neurologic Manifestation

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A sexual history should be noted, and physical examination of the anus, genital tract and abdomen are important. The rectal mucosa can be inspected via proctoscopy, to note any pustules, erythema, ulcers or bleeding. The absence of lesions and an apparently normal mucosa do not rule out gonococcal proctitis. In addition, colonoscopy should be simultaneously performed, in order to view the extent of inflammation, as it may involve the sigmoid colon.

Rectal swabs must be taken from the rectal mucosa and from any discharge which is present. These samples can be tested in a number of ways:

• Gram staining and microscopy: Failure to detect gonococcal organisms does not rule out infection, and because this test is operator dependent, sensitivity is compromised [3] [4]. Despite this, its possible sensitivity is as high as 95% [2]. The concurrent use of other tests is recommended.
• Culture: This is currently the gold standard test.
• Polymerase chain reaction (PCR): PCR has a high sensitivity, hence its frequent use.
• Nucleic acid hybridization test
• Nucleic acid amplification test (NAAT): There is no consensus among medical professionals on the use of NAAT, and it is generally unauthorized for use on the rectal mucosa, however, many practitioners and laboratories have used it with success, under specific procedural guidelines [5] [6].

Genital and pharyngeal swabs may also be cultured along with rectal swabs. Further laboratory tests to be carried out are complete blood count, where a raised leukocyte count may be present, as well as anemia due to rectal hemorrhage, and the measurement of inflammatory markers such as C-reactive protein (CRP) which may be elevated, especially in patients with proximal involvement of the colon. Testing for chlamydial infection is indicated as co-infection is common. Partners of infected persons should also be notified and treated. Other organisms that may be tested include herpes simplex virus and Treponema pallidum, using the appropriate diagnostic tools.

• Multiple Ulcerations

  Colonoscopic examination disclosed reddish and granular mucosa from rectum to sigmoid colon and multiple ulcerative lesions in the rectum. [jstage.jst.go.jp]

Two men sought treatment at an emergency room with apparent gonococcal proctitis. [ncbi.nlm.nih.gov]

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Treatment advice Reduced susceptibility to the first line treatment of IMI Ceftriaxone and Azithromycin is emerging in urban Australia. [sti.guidelines.org.au]

Prognosis Proctitis caused by bacteria is curable with antibiotics. Genital herpes is not curable. Although symptoms can be suppressed, proctitis may reoccur. [encyclopedia.com]

Prognosis is typically very good if the diagnosis is made early and treated properly. [infectiousdiseaseadvisor.com]

Prognosis Failure rates as high as 35% have been reported following treatment of rectal gonorrhea; symptoms frequently recur. [emedicine.medscape.com]

Prognosis If gonorrhea infections are diagnosed and treated quickly and correctly, recovery usually is complete unless pelvic inflammatory disease (PID) develops. PID is more likely to develop if treatment is delayed. [womenshealthmag.com]

Prognosis [ 6 ] Where treatment is rapidly received for a recently acquired gonorrhoeal infection, prognosis is good with full recovery as normal. [patient.info]

Proctitis is the inflammation of the rectal mucosa due to a number of infectious and non-infectious etiologies. Gonococcal proctitis is inflammation caused by the organism Neisseria gonorrhoeae. [symptoma.com]

The etiologic agent, NEISSERIA GONORRHOEAE, was isolated by Neisser in 1879. Definition (CSP) acute infectious disease characterized by primary invasion of the urogenital tract; the etiologic agent is Neisseria gonorrhoeae. [fpnotebook.com]

Toxins (eg, hydrogen peroxide enemas) Vasculitis Cytomegalovirus (CMV) Clostridium difficile Campylobacter species Epidemiology United States data Frequencies of proctitis are associated with their individual etiologies. [emedicine.medscape.com]

Etiology The etiology of most cases of NGU is not known however, Chlamydia trachomatis serovars D-K is a frequent cause (15%--55% of cases). The prevalence differs by age group, with fewer infections associated with this organism among older men. [atsu.edu]

The most common etiology of acute urethritis is N. gonorrhoeae, which leads to GCU. All other etiologies of urethritis are deemed NGU. NGU is seen two times as often as GCU in the United States. [infectiousdiseaseadvisor.com]

Epidemiology References: [1] [2] [3] [4] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

Epidemiology Gonococcal infection is the second most common bacterial disease in the United States that is classified as a reportable and notifiable infection. [pedsinreview.aappublications.org]

Chlamydia is under epidemiological surveillance within the EU. The reported national incidence rates vary widely and most of the more than 250 000 cases reported to ECDC for 2007 were notified by only five countries. [ecdc.europa.eu]

Explore these free sample topics: -- The first section of this topic is shown below -- Basics Description Acute or chronic inflammation of the rectal mucosa Epidemiology Incidence Predominant age: adults Predominant sex: male female Ulcerative colitis [unboundmedicine.com]

[…] therapy Immunodeficiency disorders Crohn disease Syphilis (usually secondary) Papillomavirus Amebiasis Lymphogranuloma venereum Ischemia Toxins (eg, hydrogen peroxide enemas) Vasculitis Cytomegalovirus (CMV) Clostridium difficile Campylobacter species Epidemiology [emedicine.medscape.com]

Pathophysiology Gonococcal infections tend to be associated with the acute onset of symptoms and purulent mucosal drainage due to the organism's ability to recruit polymorphonuclear leukocytes (PMNs). [pedsinreview.aappublications.org]

Etiology and Pathophysiology Chronic radiation proctitis secondary to ischemic and fibrotic changes DP: Proximal fecal diversion causes increased nitrate-reducing bacteria and decreased obligate anaerobes resulting in short-chain fatty acids (SCFAs) deficiency [unboundmedicine.com]

Pathophysiology Proctitis involves mucosal cell loss, acute inflammation of the lamina propria, eosinophilic crypt abscess, and endothelial edema of the arterioles. [emedicine.medscape.com]

Pathophysiology In genetically predisposed individuals with dysregulated immune responses, GI infections may increase the risk of ulcerative proctitis (UP). Appendectomy and smoking appeared to act as protective factors from UP. [statpearls.com]

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Additional Info CDC National Prevention Information Network (NPIN) National Center for HIV, STD and TB Prevention P.O. [womenshealthmag.com]

1. Kent CK, Chaw JK, Wong W, et al. Prevalence of rectal, urethral, and pharyngeal chlamydia and gonorrhea detected in 2 clinical settings among men who have sex with men: San Francisco, California, 2003. Clin Infect Dis. 2005;41(1):67–74.
2. Bignell C, Fitzgerald M. UK national guideline for the management of gonorrhoea in adults. Int J STD AIDS. 2011;22(10):541–547.
3. Sherrard J, Barlow D. Gonorrhoea in men: clinical and diagnostic aspects. Genitourin Med. 1996;72(6):422–426.
4. Workowski KA, Berman S. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59(RR-12):1–110.
5. Deheragoda P. Diagnosis of rectal gonorrhoea by blind anorectal swabs compared with direct vision swabs taken via a proctoscope. Br J Vener Dis. 1977;53(5):311–313.
6. Centers for Disease Control and Prevention (CDC). Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. 2007;56(14):332–336.