Infectious proctitis: a necessary differential diagnosis in ulcerative colitis

Int J Colorectal Dis. 2019 Feb;34(2):359-362. doi: 10.1007/s00384-018-3185-5. Epub 2018 Nov 6.


Introduction: In the last years, there was a rising in the incidence of sexually transmitted infections, including proctitis. Infectious proctitis (IP), mainly caused by agents like Neisseria gonorrhea and Chlamydia trachomatis, is an entity that should be considered when patients with suspected inflammatory bowel disease (IBD) are approached, mainly if they have risk factors such as anal intercourse.

Clinical cases/discussion: The symptoms of IP, like rectal blood, mucous discharge, and anorectal pain, may appear in other causes of proctitis, like IBD. Therefore, to establish the diagnosis, it is crucial to take a detailed history and perform a physical examination, with the diagnosis being supported by complementary tests such as rectosigmoidoscopy, histology, serology, and culture. Depending on the etiology, treatment of IP is based in antibiotics or antivirals, which may be empirically initiated. Co-infections, mainly those that are sexually transmitted, and HIV should be tested and sexual partners should be treated, accordingly. In this article, the authors report three cases of IP, referent to three different patients, and review the initial approach required in cases where there is a clinical and/or endoscopic suspicion of this pathology.

Keywords: Clinical history; Rectal inflammation; Sexually transmitted infections.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Colitis, Ulcerative / diagnosis*
  • Colitis, Ulcerative / microbiology
  • Colitis, Ulcerative / parasitology
  • Colitis, Ulcerative / virology
  • Diagnosis, Differential
  • Humans
  • Intraabdominal Infections / diagnosis*
  • Intraabdominal Infections / microbiology
  • Intraabdominal Infections / parasitology
  • Intraabdominal Infections / virology
  • Male
  • Middle Aged
  • Proctitis / diagnosis*
  • Young Adult