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Sexually transmitted gastrointestinal syndromes include proctitis, proctocolitis, and enteritis. Evaluation for these syndromes should include appropriate diagnostic procedures e. Proctitis is inflammation of the rectum i. In persons with HIV infection, herpes proctitis can be especially severe. Proctitis occurs predominantly among persons who participate in receptive anal intercourse. Proctocolitis is associated with symptoms of proctitis, diarrhea or abdominal cramps, and inflammation of the colonic mucosa extending to anal ids cm above the anus. Fecal leukocytes might be detected on stool examination, depending on the pathogen.

Pathogenic organisms include Campylobacter sp. Proctocolitis can be acquired through receptive anal intercourse or by oral-anal contact, depending on the pathogen. Enteritis anal ids in diarrhea and abdominal cramping without s of proctitis or proctocolitis; it occurs among persons whose sexual practices include oral-anal contact. In otherwise healthy persons, Giardia lamblia is most frequently implicated.

When outbreaks of gastrointestinal illness occur among social or sexual networks of MSM, clinicians should consider sexual transmission as a mode of spread and provide counseling accordingly. Among persons with HIV infection, enteritis can be caused by pathogens that may not be sexually transmitted, including CMV, Mycobacterium avium — intracellulareSalmonella sp.

Multiple stool examinations might be necessary to detect Giardiaand special stool preparations are required to diagnose cryptosporidiosis and microsporidiosis. In addition, enteritis can be directly caused by HIV infection. Diagnostic and treatment recommendations for all enteric infections are beyond the scope of these guidelines.

Persons who present with symptoms of acute proctitis should be examined by anoscopy.

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A Gram-stained smear of any anorectal exudate from anoscopic or anal examination should be examined for polymorphonuclear leukocytes. If the C. Acute proctitis of recent onset among persons who have recently practiced receptive anal intercourse is usually sexually acquiredPresumptive therapy should be initiated while awaiting of laboratory tests for persons with anorectal exudate detected on examination or polymorphonuclear leukocytes detected on a Gram-stained smear of anorectal exudate or secretions; such therapy also should be initiated when anoscopy or Gram stain is unavailable and the clinical presentation is consistent with acute proctitis in persons reporting receptive anal intercourse.

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Please refer to the MMWR for more information. If painful perianal ulcers are present or mucosal ulcers are detected on anoscopy, presumptive therapy should also include a regimen for genital herpes see Genital HSV Infections. To minimize transmission and reinfection, men treated for acute proctitis should be instructed to abstain from sexual intercourse until they and their partner s have been adequately treated i. All persons with acute proctitis should be anal ids for HIV and syphilis.

Follow-up should be based on specific etiology and severity of clinical symptoms. For proctitis associated with gonorrhea or chlamydia, retesting for the respective pathogen should be performed 3 months after treatment. Partners who have had sexual contact with persons treated for GC, CT, or LGV within the 60 days before the onset of the persons symptoms should be evaluated, tested, and presumptively treated for the respective pathogen.

Partners of persons with sexually transmitted enteric infections should be evaluated for any diseases diagnosed in the person with acute proctitis. Sex partners should abstain from sexual intercourse until they and their partner with acute proctitis are adequately treated. Allergic reactions with third-generation cephalosporins e. In those persons with a history of an IgE mediated penicillin allergy e. Persons with HIV infection and acute proctitis may present with bloody discharge, painful perianal ulcers, or mucosal ulcers.

Presumptive treatment should include a regimen for genital herpes and LGV. Skip directly to site content Skip directly to options Skip directly to A-Z link. Section. Facebook Twitter LinkedIn Syndicate. Links with this icon indicate that you are leaving the CDC website. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or anal ids information and products presented on the website. You will be subject to the destination website's privacy policy when you follow the link.

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