Anal discharge and/or pain are typical symptoms of proctitis.
Symptoms | Considerations |
---|---|
Anal discharge |
Mucopurulent or light blood staining. May be subtle. |
Anal pain |
Often accompanied by spasm. May preclude proctoscopy. |
Perianal ulcers and systemic features |
If present suggest herpes or syphilis |
Altered bowel habit | Constipation predominates in proctitis. Alternating constipation and diarrhoea occurs in proctocolitis. |
Tenesmus | Sensation of needing to pass stools indicates inflammation of anal canal. |
Infection | Site/Specimen | Test |
---|---|---|
Swab of ulcer |
NAAT |
|
Ano-rectal swab |
If NAAT test result is positive, collect swab for culture before treatment, to assess antibiotic sensitivity. This should not delay treatment |
|
Ano-rectal swab |
NAAT, LGV testing if reactive. |
|
NAAT – Nucelic acid amplification test |
These should always be clinician collected as the patient should be examined. Ideally this should be done via proctoscope. If patients are reluctant to undergo anorectal examination the importance and benefits of physical examination should be explained with respect to achieving an accurate diagnosis and appropriate management plan.
Syndromic Treatment of nonspecific proctitis | ||
---|---|---|
• doxycycline 100mg PO bd for 21 days, • PLUS ceftriaxone 500mg in 2mL of 1% lignocaine, IMI stat • PLUS Valaciclovir 500mg PO, BD for 5 - 10 days. |
See Australasian Contact Tracing Manual for more information.
If confirmed STI, follow up provides an opportunity to:
For test of cure (TOC) and retesting advice see: