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This document is being maintained for historical purposes, but is now out of date.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

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1993 Sexually Transmitted Diseases Treatment Guidelines

09/24/1993

SUGGESTED CITATION
Centers for Disease Control and Prevention. 1993 Sexually
transmitted diseases treatment guidelines. MMWR 1993;42(No. RR-14):
{inclusive page numbers}.

CIO Responsible for this publication:
National Center for Prevention Services,
Division of Sexually Transmitted Diseases and HIV 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 may be acquired by either route
depending on the pathogen. Evaluation should include appropriate
diagnostic procedures, such as anoscopy or sigmoidoscopy, stool
examination, and culture.

     Proctitis is an inflammation limited to the rectum (the distal
10 cm-12 cm) that is associated with anorectal pain, tenesmus, and
rectal discharge. N. gonorrhoeae, C. trachomatis (including LGV
serovars), T. pallidum, and HSV are the most common sexually
transmitted pathogens involved. Among 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. Pathogenic organisms include
Campylobacter spp, Shigella spp, Entamoeba histolytica, and,
rarely, C. trachomatis (LGV serovars). CMV or other opportunistic
agents may be involved among immunosuppressed patients with HIV
infection.

     Enteritis usually results in diarrhea and abdominal cramping
without signs of proctitis or proctocolitis. In otherwise healthy
patients, Giardia lamblia is most commonly implicated. Among
patients with HIV infection, other infections that are not
generally sexually transmitted may occur, including CMV,
Mycobacterium avium-intracellulare, Salmonella spp,
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 further laboratory tests.

Recommended Regimen -
     Ceftriaxone 125 mg IM (or another agent effective against anal
     and genital gonorrhea)
                         and
     Doxycycline 100 mg orally 2 times a day for 7 days.

NOTE: For patients with herpes proctitis, refer to Genital
Herpes Simplex Virus Infections.

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

     Partners of patients with sexually transmitted enteric
infections should be evaluated for any diseases diagnosed in the
index patient.

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