SEXUALLY TRANSMITTED GASTROINTESTINAL DISORDERS – CLINICAL FEATURES AND MANAGEMENT
The symptoms of proctitis will vary depending on the cause and may
include anorectal pain, pruritis, mucopurulent or bloody discharge, tenesmus and, in severe cases, constipation. Many anorectal infections are asymptomatic. Erythema, oedema, exudate or tenderness on palpation may be noted on examination. N gonorrhoeae, ะก trachomatis and HSV are common causes of proctitis. Proctitis may be due to chemicals in lubricants, enemas, and shampoos resulting from direct or allergic contact reactions.
Primary rectal lesions may occur in syphilis, HPV, donovanosis or lymphogranuloma venereum. G lamblia is the predominant sexually transmitted cause of enteritis. Shigella and Campylobacter species and E histolytica may cause colitis or entercolitis.
It is important to be alert to the possibility of sexually transmitted gastrointestinal disease. Clinical assessment should include inquiry about anal coitus and other sexual practices and examination of the anorectal area.
Investigation of proctitis should include swabbing of inflamed areas for microscopy and culture with selective media . Biopsy may be necessary to establish the diagnosis and to exclude malignancy.
Treatment will depend on the cause. Treatment of asymptomatic E histolytica is usually not indicated.
Amoebiasis may involve the cervix, vagina, penis, perineum or anus. Anogenital amoebiasis may be transmitted by sexual intercourse. In tropical areas, amoebiasis should be included in the differential diagnosis of genital ulcer, balanitis and genital and perianal neoplasms. Investigations should include smears or biopsy of the lesion. In third world countries, trial of therapy may be appropriate.
Amoebiasis can be treated with metronidazole (e.g. 2 g orally in one dose daily for 3 days followed by diloxanide furoate 500 mg 3 times a day for 10 days.)
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