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.

• Anemia

  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 [symptoma.com]

  Anemia can cause you to have pale skin, irritability, weakness, dizziness, brittle nails, and shortness of breath. [emedicinehealth.com]

  Complications such as severe bleeding and anemia need immediate medical attention. As a result of severe diarrhea, you also may be dehydrated. [webmd.com]

  If you have severe bleeding associated with proctitis, you may develop anemia (from loss of blood). Anemia can cause pale skin, irritability, weakness, dizziness, brittle nails, and shortness of breath. [tipdisease.com]

  If there is severe bleeding, anemia can result, showing symptoms such as pale skin, irritability, weakness, dizziness, brittle nails, and shortness of breath. [en.wikipedia.org]

• Lymphadenopathy

  Conjunctivitis -adults: cobblestone appearance of conjunctiva -newborns- mucopurulent discharge (could be bloody) Serovars A-C Trachoma Chlamydia trachiomatis Serovar L- spread to lymphatic tissue Tropics- genital ulcer w/ later significiant inguinal lymphadenopathy [quizlet.com]

  Discriminating factors from IBD include urethral or vaginal mucopurulent discharge, and painful inguinal and femoral lymphadenopathy may be present that can progress to abscess formation. [fg.bmj.com]

  Physical examination findings may include oropharyngeal erythema or exudates, and cervical lymphadenopathy. [aafp.org]

  Those due to STI’s may show perianal or rectal ulcers, chancres, condyloma, or tender inguinal lymphadenopathy. IBD-associated/radiation proctitis present with anal fistula/fissures, perianal abscesses, rectal bleeding or guaiac-positive stools. [statpearls.com]

  It may have multi-system manifestation, including osteitis, hepatitis, lymphadenopathy, pneumonitis, mucocutaneous lesions, anemia, and hemorrhage. E. [meddean.luc.edu]

• Unsafe Sexual Practices

  […] history of any STD Having a partner with an unknown sexual history Using drugs or alcohol (these may increase the likelihood of unsafe sexual practices) Having a partner who is an IV drug user Bisexual or homosexual partners Anal intercourse ( Anal sex [webmd.com]

  […] history of any STD Having a partner with an unknown sexual history Using drugs or alcohol (these may increase the likelihood of unsafe sexual practices) Having a partner who is an IV drug user Bisexual or homosexual partners Anal intercourse (Anal sex [emedicinehealth.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]

• Rhinitis

  Less severe manifestations include rhinitis, vaginitis, urethritis, and inflammation at sites of fetal monitoring. Epidemiology Humans are the only known host and infection is almost always via sexual contact. [atsu.edu]

  […] can occur in neonates from exposure to infected cervical secretions during delivery. 5 Sepsis, neonatal conjunctivitis (ophthalmia neonatorum), meningitis, and arthritis are the most severe complications. 1 Other manifestations include pharyngitis, rhinitis [aafp.org]

• 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]

  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]

  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]

• Abdominal Pain

  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]

  Some of the side affects attributed to mesalamine have been reported as: Rectal pain Dizziness Nausea Worsening of colitis Headaches Muscle aches Rash Abdominal pain Intracranial hypertension Fever Here's an example medication daily regimen for someone [candidacounsel.com]

  In some women, the bacteria will spread to the uterus and fallopian tubes, causing pain during intercourse, abdominal pain, abnormal menstrual bleeding and fever. [womenshealthmag.com]

  Women can also have painful periods, bleeding between periods, pain during sex, abdominal pain, or a fever. Men can also have a less common symptom of swelling or pain in either or both testicles. [plushcare.com]

  The fallopian tubes swell with pus, causing acute abdominal pain. Infertility occurs when inflammatory adhesions close the tubes at both ends, blocking the ascent of sperm and the descent of ova. [histopathology-india.net]

• Rectal Pain

  Mild symptoms include rectal pain with bowel movements, rectal discharge, and cramping. With severe cases, people may have discharge containing blood or pus, severe rectal pain, and diarrhea. [en.wikipedia.org]

  Other common symptoms include but are not limited to: bloody bowel movements rectal bleeding a feeling of rectal fullness and incomplete evacuation anal or rectal pain soreness in your anal and rectal area severe cramps or pain during bowel movements [premiermedicalhv.com]

  Common symptoms are rectal bleeding and rectal pain. Definition : When inflammation occurs in the rectum and the lower part of the colon, the last 15-20 cm, you have ulcerative proctitis. [candidacounsel.com]

  Mild symptoms might be mild rectal pain with bowel movement, anal discharge, and cramping. With a severe case, you may have discharge containing blood and pus, severe rectal pain, and diarrhea. [emedicinehealth.com]

• Rectal Discharge

  Rectal swabs must be taken from the rectal mucosa and from any discharge which is present. [symptoma.com]

  Proctitis is inflammation of the rectum (i.e., the distal 10–12 cm) that can be associated with anorectal pain, tenesmus, or rectal discharge. [cdc.gov]

  When symptoms occur, they commonly include rectal pain or itching, a rectal discharge that contains blood, mucus, pus or a persistent urge to move the bowels. [womenshealthmag.com]

  Mild symptoms include rectal pain with bowel movements, rectal discharge, and cramping. With severe cases, people may have discharge containing blood or pus, severe rectal pain, and diarrhea. [en.wikipedia.org]

  Proctitis Proctitis manifests as anal pruritis and rectal discharge. The infection is limited to the rectum and resembles gonococcal proctitis. Asymptomatic rectal infections are common. [ecdc.europa.eu]

• Lower Abdominal Pain

  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]

  Women can also have painful periods, bleeding between periods, pain during sex, abdominal pain, or a fever. Men can also have a less common symptom of swelling or pain in either or both testicles. [plushcare.com]

  Pelvic/lower abdominal tenderness (uncommon, 5%). Normal examination (very common). [patient.info]

  Symptoms of proctitis are non-discriminatory including lower abdominal pain, diarrhoea, rectal bleeding and tenesmus; however, it may be associated with an anorectal purulent discharge. [fg.bmj.com]

• Palpitations

  If the bleeding is severe, you may have weakness, dizziness, palpitations (feel your heart beating), and tiredness - all signs of iron deficiency anemia from blood loss. [tipdisease.com]

• Jaundice

  If hepatitis has occurred, patients may be jaundiced with hepatomegaly and hepatic tenderness in addition to other stigmata of cirrhosis. [infectiousdiseaseadvisor.com]

• Erythema

  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. [symptoma.com]

  No nodule was observed in four patients（8.7%）at their first endoscopic examination, and “erosion”, “aphtha”, or “erythema” was observed in these patients. [webview.isho.jp]

  Despite nomenclature, SRUS may present with erythema of the rectal mucosa, polypoid inflammation or multiple rather than single ulcers. Consequently, a misdiagnosis of IBD or malignancy may be made. [fg.bmj.com]

  On urethral examination, spontaneous discharge and, specifically in men, erythema and crusting of the meatus may be found. [infectiousdiseaseadvisor.com]

  Physical examination findings may include oropharyngeal erythema or exudates, and cervical lymphadenopathy. [aafp.org]

• Pruritus

  The vaginal discharge may infect the anal crypts, leading to mucopurulent anal discharge, rectal pruritus, and tenesmus. [histopathology-india.net]

  History and Physical Anorectal symptoms consistent with proctitis and anusitis include bloody or purulent discharge and pain on defecation, digital exam or during anal intercourse and pruritus as a common complaint in anusitis. [statpearls.com]

  […] most men (90-95%) and asymptomatic in half of women. [ 4 ] Symptoms Men Urethral infection - discharge (>80%) and/or dysuria (>50%), asymptomatic ( [ 8 ] Rectal infection - usually asymptomatic; may cause anal discharge (12%) or perianal/anal pain, pruritus [patient.info]

  Infections. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5614a3.htm Management of male patients who have urethritis - Urethritis is an infection characterized by urethral discharge of mucopurulent or purulent material and sometimes by dysuria or urethral pruritus [atsu.edu]

  […] with reactive arthritis. 8, 9 Anorectal Infections More than 50 percent of rectal N. gonorrhoeae infections in men and women may be asymptomatic. 6 The highest prevalence of anorectal gonorrhea is in men who have sex with men. 1 Symptoms include anal pruritus [aafp.org]

• Petechiae

  General Haematogenous dissemination (uncommon - Skin lesions (papules, bullae, petechiae and necrotic skin lesions). Arthralgia, arthritis and tenosynovitis of the ankles, wrists, hands and feet ( Reiter's syndrome ). [patient.info]

  12 Antibioticresponsive, culture-negative acute arthritis in a sexually active young person is most often caused by disseminated gonococcal infection. 1 Skin lesions are present in 75 percent of patients with bacteremia, including painless or painful petechiae [aafp.org]

• Incontinence

  […] anus A54.6 proctitis A54.6 rectum A54.6 Proctitis K62.89 ICD-10-CM Diagnosis Code K62.89 Other specified diseases of anus and rectum 2016 2017 2018 2019 Billable/Specific Code Applicable To Proctitis NOS Use Additional code for any associated fecal incontinence [icd10data.com]

  She denies weight loss, hematochezia, melena, or fecal incontinence. Select the most likely diagnosis. [statpearls.com]

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.

• Chlamydia

  The pathogen Genital chlamydia is caused by the obligate intracellular Gram negative bacterium Chlamydia trachomatis. [ecdc.europa.eu]

  Chlamydia that goes untreated increases the chances of acquiring or transmitting HIV/AIDS. An infection with Chlamydia should prompt treatment for other STDs and testing for HIV. 6. It is easily prevented and treated. [jeffreysterlingmd.com]

  Symptoms of Gonorrhea and Chlamydia Sometimes someone with gonorrhea or chlamydia does not show any symptoms. In fact, 75% of women and 50% of men with chlamydia exhibit no symptoms. [plushcare.com]

  […] trachomatis- genital tract infections, conjunctivitis, trachoma (roughening of inner surface of eyelid) Chlamydia pneumoniae- pneumonia Chlamydia psittaci- from birds, causes pneumonia Chlamydia trachiomatis: characteristics gram (-) obligate intracellular [quizlet.com]

  We studied 46 patients with a diagnosis of Chlamydia trachomatis proctitis infection. Many patients with Chlamydia trachomatis proctitis infection show atypical nodular lesions. [webview.isho.jp]

• Treponema Pallidum

  Other organisms that may be tested include herpes simplex virus and Treponema pallidum, using the appropriate diagnostic tools. [symptoma.com]

  > syphilis Borrelia --> Lyme disease Leptospira --> Leptospirosis Treponema pallidum: characteristics Cause syphilis grows slowly no important toxins/enzymes infects endothelium of small vessels --> endarteritis sexual transmission- direct contact [quizlet.com]

  Treponema pallidum, the causative agent of syphilis can be readily visualized by. A. Light microscopy B. Darkfield microscopy 2. Treponema pallidum can be A. sustained in vitro cultivation B. [meddean.luc.edu]

  Causative organisms include Neisseria gonorrhoeae, Chlamydia trachomatis, herpes simplex virus, Treponema pallidum (syphilis), Giardia lamblia (giardiasis) and Entamoeba histolytica (amoebiasis). [fg.bmj.com]

See general treatment recommendations described under “Treatment Regimens.” [acog.org]

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

[…] of HIV in Industrialized and Middle Income CountriesŠAdults Adolescents and Pediatric 1310 Chapter 115 Guidelines for the Treatment of HIV and AIDS in ResourceLimited Countries 1328 Chapter 116 Guidelines for Prevention of Perinatal HIV Infection 1345 [books.google.de]

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

Update to CDC’s sexually transmitted diseases treatment 2010 guidelines: oral cephalosporins no longer a recommended treatment for gonococcal infections. MMWR Morb Mortal Wkly Rep. 2012a;61:590–4. Google Scholar CDC. [link.springer.com]

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]

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]

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]

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]

Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets [books.google.de]

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

Cranberries contain a substance that may prevent bacteria from sticking to the urethra. Drinking between 8 ounces and 16 ounces of unsweetened cranberry juice each day may help women with frequent urinary infections to prevent recurrence. [medicalnewstoday.com]

Treatment and Prevention Patients with this bacterial infection can be treated with doxycycline or azithromycin. Treating infected patients prevents transmission to sex partners. [atsu.edu]

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.