Infection of the GI tract may occur from anal intercourse (proctitis) or sexual activity that includes fecal-oral contact (enteritis). Proctocolitis may occur with either route. Proctitis is characterized by anorectal pain, tenesmus, and rectal discharge and may be caused by GC, C. trachomatis including LGV strains or serovars, HSV, or T. pallidum (2). Patients with acute proctitis who practice receptive anal intercourse should be examined with anoscopy to make a specific diagnosis. Although proctitis due to GC responds well to regimens recommended for uncomplicated GC infection, if pus is present on examination of the rectum, 125 mg of ceftriaxone intramuscularly plus 100 mg of doxycycline twice daily for 7 d is recommended. Rectal chlamydial infection due to the non-LGV serovars is unusual and probably responds to the regimens recommended for urethritis. LGV may cause a hemorrhagic proctitis associated with regional lymphadenitis. LGV is treated with 100 mg of doxycycline orally twice daily for 21 d or alternatively with 500 mg of erythromycin base orally four times daily for 21 d (2).
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