Roy.Soc.Med "Int Journal of STD & AIDS"

2013 European Guideline on the management of proctitis, proctocolitis and enteritis caused by sexually transmissible pathogens Henry JC de Vries1,2,3,4⇑ Adele Zingoni5 John A White6 Jonathan DC Ross7 Alexander Kreuter8 1STI outpatient clinic, Cluster Infectious Diseases, Health Service Amsterdam, Amsterdam, The Netherlands 2Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands 3Centre for Infectious Diseases and Immunology Amsterdam (CINIMA), Amsterdam, The Netherlands 4Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands 5Department of Biomedical Sciences and Human Oncology, Dermatologic Clinic, University of Turin, Turin, Italy 6Department of Genitourinary Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK 7Sexual Health Clinic – University Hospitals Birmingham NHS Foundation Trust, Whittall Street Clinic, Birmingham, UK 8Department of Dermatology, Venereology, and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, Germany HJC de Vries, STI Outpatient Clinic, Cluster Infectious Diseases, Health Service Amsterdam, Amsterdam, The Netherlands. Email: h.j.devries@amc.uva.nl Abstract Proctitis is defined as an inflammatory syndrome of the distal 10–12 cm of the anal canal, also called the rectum. Infectious proctitis can be sexually transmitted via genital-anal mucosal contact, but some also via mutual masturbation. N. gonorrhoeae, C. trachomatis (including lymphogranuloma venereum), Herpes Simplex Virus and T. pallidum are the most common sexually transmitted anorectal pathogens. Shigellosis can be transferred via oral-anal contact and may lead to proctocolitis or enteritis. Although most studies on these infections have concentrated on men who have sex with men (MSM), a significant proportion of women have anal intercourse and therefore may also be at risk. A presumptive clinical diagnosis of proctitis can be made when there are symptoms and signs, and a definitive diagnosis when the results of laboratory tests are available. The symptoms of proctitis include anorectal itching, pain, cramps (tenesmus) and discharge in and around the anal canal. Asymptomatic proctitis occurs frequently and can only be detected by laboratory tests. The majority of rectal chlamydia and gonococcal infections are asymptomatic. Therefore when there is a history of receptive anal contact, exclusion of anorectal infections is generally indicated as part of standard screening for sexually transmitted infections (STIs). Condom use does not guarantee protection from bacterial and protozoan STIs, which are often spread without penile penetration.