Patient with unprotected receptive anal intercourse reported with rectal pain, bleeding and tenesmus
A 25-year-old man presented to the gastroenterology clinic with complaints of change in bowel habits, abdominal pain and fatigue. The symptoms began 7 months ago in association with rectal pain, bleeding and tenesmus. Additionally, a week before presentation, he had diarrhoea and constipation. The patient also noted that he had lost 14 kgs of weight during this tenure. He did not report of any night sweats or fevers.
On examination the rectum was notable for anal fissure. Similarly, the patient revealed that he had had unprotected receptive anal intercourse in the past. Colonoscopy showed severe ulcerative proctitis which ruled out the possibility of inflammatory bowel disease. The specimens were biopsied to confirm the diagnosis. Findings of the pathological analysis were consistent with active proctitis with lymphocytic inflammation.
Immunohistochemical staining was positive for Treponema pallidum. A polymerase-chain-reaction assay of a sample obtained from a rectal swab was positive for Chlamydia trachomatis L serovars and negative for gonorrhea. Similarly, rapid plasma reagin testing was positive at a titer of 1:32. Human immunodeficiency virus testing was negative.
The patient was diagnosed with infectious proctitis with syphilis associated with lymphogranuloma venereum.
The symptoms of endoscopic appearance of infectious proctitis, in some cases, are quite similar to inflammatory bowel disease. The patient was prescribed benzylpenicillin, azithromycin, and a 21-day course of doxycycline. The symptoms completely resolved after the course of medications was completed.
Siddiqui, W. T., & Schwartz, H. M. (2020). Infectious Proctitis. The New England Journal of Medicine, 382(17), 1638-1638.