Proctitis

Etiology

Lymphogranuloma venereum (LGV) is caused by Chlamydia trachomatis serovars L1 to L3. (C. trachomatis serovars B and D-K are responsible for the syndromes of non-gonococcal urethritis and cervicitis.)

Clinical manifestations

The primary lesion produced by LGV is a small, non-painful genital papule, which can ulcerate at the site of inoculation after an incubation period of three to 30 days. This lesion can remain undetected within the urethra, vaginal vault, or rectum.

Common clinical manifestations include (1) tender, unilateral, or bilateral inguinal and/or femoral adenopathy, which can become fluctuant; and (2) hemorrhagic proctitis or proctocolitis, which is associated with receptive anal intercourse. The clinical and histologic presentation of LGV proctocolitis can be similar to the initial manifestations of inflammatory bowel disease.

Diagnosis

Diagnosis is based primarily on clinical findings; routine laboratory confirmation might not be possible.

Serologic tests for C. trachomatis (i.e., microimmuno-fluorescence or complement fixation) can support diagnosis.

Direct identification of C. trachomatis from a lesion (i.e., bubo) or site of the infection (e.g., rectum) can be made by using culture or by using nonculture nucleic acid testing; however, neither method is specific for LGV, and use of rectal swabs for nucleic acid testing is not cleared by the U.S. Food and Drug Administration.

Treatment

The recommended treatment is administration of 10 mg of doxycycline, twice daily for 21 days. Alternative treatment is 500 mg of erythromycin base orally, four times a day for 21 days. Some subspecialists believe 1 g of azithromycin, administered orally once weekly for three weeks, is effective; however, clinical data are lacking.

Sex partners who had contact with the patient within 30 days of the patient's onset of symptoms should be evaluated; in the absence of symptoms, they should be treated with either 1 g of azithromycin in a single dose, or 100 mg of doxycycline, twice a day for seven days.

COPYRIGHT 2005 American Academy of Family Physicians
COPYRIGHT 2005 Gale Group