Infectious proctitis: when to suspect it is not inflammatory bowel disease

Dig Dis Sci. 2012 Feb;57(2):269-73. doi: 10.1007/s10620-011-1935-0. Epub 2011 Oct 13.


Background: Proctitis is a common problem and is most frequently associated with inflammatory bowel diseases. However, the incidence of infectious proctitis appears to be rising, especially in men who have sex with men. This may be due to the rise of people participating in receptive anal sex as well as the increase in sexually transmitted infections. The most frequently reported pathogens include Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, and herpes simplex.

Diagnosis: Symptoms of infectious proctitis can include rectal blood and mucous discharge, anorectal pain, ulcers, and occasionally lymphadenopathy and fever. History and physical examination are crucial in establishing a diagnosis, supported by endoscopy, histology, serology, culture and PCR.

Treatment: Treatment with antibiotics or antivirals is usually initiated, either empirically or after establishing a diagnosis. Co-infections, HIV testing, and treatment of sexual partners should always be considered.

Publication types

  • Review

MeSH terms

  • Chlamydia Infections / diagnosis
  • Chlamydia Infections / drug therapy
  • Diagnosis, Differential
  • Endoscopy, Gastrointestinal*
  • Gonorrhea / complications
  • Gonorrhea / drug therapy
  • Herpes Simplex / complications
  • Homosexuality, Male
  • Humans
  • Inflammatory Bowel Diseases / diagnosis*
  • Lymphogranuloma Venereum / drug therapy
  • Male
  • Proctitis / diagnosis*
  • Proctitis / microbiology*
  • Proctitis / virology
  • Simplexvirus / physiology
  • Syphilis / drug therapy
  • Virus Latency