sexually transmitted proctitis

This patient’s presentation of tenesmus, purulent discharge, and small-volume stools containing blood is consistent with proctitis.  Proctitis has multiple causes, including ulcerative colitis, radiation treatment, and infections.  Given this patient’s history, a sexually transmitted infection is most likely.  Neisseria gonorrhoeae is the most common cause of sexually transmitted proctitis in individuals with history of anal-receptive intercourse.

Patients with rectal symptoms should undergo anoscopy or sigmoidoscopy with mucosal biopsies.  Purulent discharge should be cultured and sent for Gram stain, Tzanck prep and culture for herpes simplex virus, and PCR for Chlamydia trachomatis.  In addition, patients should have serum RPR and HIV.  Treatment is based on results of the investigation.