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Warning:
This document is being maintained for historical purposes, but is now out of date. To view current guidelines please visit:
- STD Treatment Guidelines at http://www.cdc.gov/STD/treatment
1998 Guidelines for Treatment of Sexually Transmitted Disease
Date: 01/23/98
Source: 47(RR-1);1-118
SUGGESTED CITATION: Centers for Disease Control and Prevention. 1998 Guidelines for Treatment of Sexually Transmitted Diseases. MMWR 1998;47(No. RR-1): {inclusive page numbers}.
The material in this report was prepared for publication by: National Center for HIV, STD and TB Prevention, Division of Sexually Transmitted Diseases Prevention
PROCTITIS, PROCTOCOLITIS, AND ENTERITIS
Sexually transmitted gastrointestinal syndromes include proctitis, proctocolitis, and enteritis. Proctitis occurs predominantly among persons who participate in anal intercourse, and enteritis occurs among those whose sexual practices include oral-fecal contact. Proctocolitis can be acquired by either route, depending on the pathogen. Evaluation should include appropriate diagnostic procedures (e.g., anoscopy or sigmoidoscopy, stool examination, and culture).
Proctitis is an inflammation limited to the rectum (the distal 10-12 cm) that is associated with anorectal pain, tenesmus, and rectal discharge. N. gonorrhoeae, C. trachomatis (including LGV serovars), T. pallidum, and HSV usually are the sexually transmitted pathogens involved. In patients coinfected with HIV, herpes proctitis may be especially severe.
Proctocolitis is associated with symptoms of proctitis plus diarrhea and/or abdominal cramps and inflammation of the colonic mucosa extending to 12 cm. Fecal leukocytes may be detected on stool examination depending on the pathogen. Pathogenic organisms include Campylobacter sp., Shigella sp., Entamoeba histolytica, and, rarely, C. trachomatis (LGV serovars). CMV or other opportunistic agents may be involved in immunosuppressed HIV-infected patients.
Enteritis usually results in diarrhea and abdominal cramping without signs of proctitis or proctocolitis. In otherwise healthy patients, Giardia lamblia is most frequently implicated. Among HIV-infected patients, other infections that usually are not sexually transmitted may occur, including CMV, Mycobacterium avium-intracellulare, Salmonella sp., Cryptosporidium, Microsporidium, and Isospora. Multiple stool examinations may be necessary to detect Giardia, and special stool preparations are required to diagnose cryptosporidiosis and microsporidiosis. Additionally, enteritis may be a primary effect of HIV infection.
When laboratory diagnostic capabilities are available, treatment should be based on the specific diagnosis. Diagnostic and treatment recommendations for all enteric infections are beyond the scope of these guidelines.
Treatment
Acute proctitis of recent onset among persons who have recently practiced receptive anal intercourse is most often sexually transmitted. Such patients should be examined by anoscopy and should be evaluated for infection with HSV, N. gonorrhoeae, C. trachomatis, and T. pallidum. If anorectal pus is found on examination, or if polymorphonuclear leukocytes are found on a Gram-stained smear of anorectal secretions, the following therapy may be prescribed pending results of additional laboratory tests.
Recommended Regimen
Ceftriaxone 125 mg IM (or another agent effective against anal and genital gonorrhea),
PLUS
Doxycycline 100 mg orally twice a day for 7 days.
NOTE: For patients who have herpes proctitis, refer to Genital Herpes Simplex Virus (HSV) Infection.
Follow-Up
Follow-up should be based on specific etiology and severity of clinical symptoms. Reinfection may be difficult to distinguish from treatment failure.
Management of Sex Partners
Sex partners of patients who have sexually transmitted enteric infections should be evaluated for any diseases diagnosed in the patient.
