Success in the management of patients with acute venereal proctitis depends on suspecting the diagnosis, obtaining specimens to confirm the diagnosis, and initiating therapy as expeditiously as possible. Patients presenting with symptoms of anorectal pain, rectal discharge, and/or tenesmus should be considered to have proctitis until proven otherwise. Anoscopy or proctoscopy, and a Gram stain should be performed to document the presence of acute proctitis. In addition to the appropriate culture specimens, blood should be drawn to check for syphilis.
Antibiotic therapy should not be delayed, pending the results of cultures. Empirical therapy aimed at eradicating gonorrhea, non-LGV chlamydia, and incubating syphilis should be initiated for any patient presenting with symptoms and physical signs suggestive of acute proctitis. This therapy should be administered to all patients with acute proctitis even if there are concomitant lesions suggestive of herpetic or papilloma virus infections. Uncomplicated cases of venereal proctitis respond to the same antiobiotic regimens used for venereal urethritis or cervicitis. (see ChaR 137). As is the case for STDs in general, these patients must be referred for appropriate follow-up to ensure completion of therapy and eradication of disease.
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