One fact about STDs not often talked about is that they can trigger other syndromes. Previously, we discussed how cervicitis can develop in women when gonorrhea, chlamydia, trichomoniasis or genital herpes is present. However, syndromes related to STDs are not only limited to the reproductive tract or genitals. Proctitis is a gastrointestinal syndrome which can occur due to STDs. An inflammation of the rectum’s lining, proctitis chiefly takes place among sexually active people who have receptive anal sex.
The rectum is a passage from which stool makes its way out of the body. According to the Centers of Disease Control and Prevention (CDC), anorectal pain, tenesmus (the urgency to pass stool even when the bowel is already empty), and rectal discharge are indicative of proctitis. In some cases, bleeding also happens along with the discharge of mucus or pus.
Causes and Risk Factors of Proctitis
Not limited to STDs, a number of other factors can lead to a person contracting the disease.
- STD. Receptive anal sex (oral-anal, digital-anal, or genital-anal) is how proctitis can be acquired since STDs spread through sexual contact. Below are the most common proctitis-causing STI pathogens according to the CDC:
- Gonorrhea. Gonorrhea is one of the most familiar causes of proctitis. Gonorrheal proctitis is usually signified by mucopurulent (containing both mucus and pus) discharge, tenesmus and pruritus. Although not always, bleeding may happen in several cases. Other characteristics of gonorrheal proctitis include erythema, mucosal edema and plaques that are spotted on the rectum.
- Chlamydia. Anorectum problems resulting from Chlamydia trachomatis infections can be asymptomatic (especially the non-LGV ones). But, if symptoms are present, they usually revolve around urgency to defecate, pain and fever. Another type of Chlamydia trachomatis infections is the ones that have to do with lymphogranuloma venereum (LGV), which is an aggressive form of chlamydia. Caused by L1-L3 serovars of Chlamydia trachomatis, LGV anorectal inflammations are systemic and indicated by the presence of papules, abscesses and buboes.
- Syphilis. Since syphilis occurs in stages, the symptoms of anorectal infections because of this STD vary depending on whether it is primary or secondary syphilis. The first sign of primary syphilis in the anorectum is the emergence of a chancre. 2 to 6 weeks after the incubation period, an ulcer will appear. Anorectal ulcers cause pain and can be mistaken for anal fissures. Several defining attributes that separate syphilis ulcers from anal fissures are the size (syphilis ulcers are broad) and location (between the anal verge and dentate line).
- Herpes. Although genital herpes (HSV-2) is more closely related to sexual contact, the surge of frequency of oral-genital sex makes both HSV-1 and HSV-2 can be found in any location. It is believed that proctitis emerging from HSV makes its way from the perianal skin into the anal canal and the rectum. Besides being prevalent in people who have anoreceptive sex, HSV proctitis is also common in patients who are immunosuppressed from organ or bone marrow transplantations. Along with rectal pain, tenesmus or bleeding, patients may also suffer from fecal incontinence and difficulty when urinating.
- Non-STD infections. Bacterial infections which are not transmitted sexually can also cause proctitis. For instance, salmonella and shigella are two common culprits behind this syndrome.
- Inflammatory bowel diseases. Crohn’s disease or ulcerative colitis are two forms of IBDs that are proctitis-causing. Ulcerative colitis can lead to sores which line the inner part of the colon while Crohn’s disease usually irritates the lower intestine or the colon.
- Radiation therapy. People who undergo radiation therapy targeting areas near the rectum (pelvic areas) or the rectum itself can develop radiation proctitis which can appear during the treatment until after treatment has finished. For instance, people with ovarian or prostate cancer who undergo radiation therapy are at risk for developing this syndrome.
- Antibiotics. In some instances, the use of antibiotics that is targeted to eliminate an infection may also kill helpful bacteria in the gastrointestinal tract. When this happens, there is a chance for harmful bacteria called Clostridium difficile to flourish and infect the colon or rectum.
Anoscopy, rectal culture and colonoscopy are three methods which can be employed to diagnose proctitis. Before getting to either one of those procedures, however, healthcare professionals will first examine a person’s medical history. This includes performing a physical exam and getting to know more about an individual’s past and present medical conditions to determine which lab and diagnostic tests are fitting.
- Anoscopy. This diagnostic test examines the anal canal and lower rectum with the use of a tool called anoscope through the anus. Additionally, individuals should also be tested for gonorrhea, chlamydia, LGV, and syphilis.
- Rectal culture. This procedure involves swabbing the rectum with cotton to identify the organisms that are causing the disease.
- Colonoscopy. Colonoscopy is a method utilized to diagnose Crohn’s disease. Normally, prior to the procedure, patients should follow a clear liquid diet 1 to 3 days before the test.
Every test will involve the use of a camera so that doctors can see the current conditions of the intestinal lining. This way, any bleeding, ulcers and inflammation on the colon wall can be detected.
Treatment of proctitis entirely depends on its cause. Proctitis resulting from bacterial STDs such as gonorrhea and chlamydia is treated with antibiotics while antiviral medications are prescribed to control the symptoms of proctitis emerging from viral STDs such as herpes (since some STD viruses cannot be entirely eliminated).
If, however, a person has proctitis due to consuming antibiotics, doctors will prescribe a particular kind of antibiotic to destroy the harmful bacteria. As for radiation proctitis, depending on the severity and frequency of the bleeding, thermal therapy (the use of heat probe, electric current or laser) will be performed during sigmoidoscopy or colonoscopy.
Untreated proctitis can lead to anemia (due to severe bleeding), ulcers and fistulas.
Getting STD testing regularly for gonorrhea, syphilis, chlamydia, LGV and herpes is one of the ways a person can make sure proctitis does not get out of hand. Shim Clinic is a STD clinic based in Singapore providing STD screening, diagnosis and STD treatment. We also provide STD prevention methods such as HIV PEP, HIV PrEP, and HPV vaccination (Gardasil-9).