Framework for proctitis:
- infectious: (HSV and chlamydia are starred and bolded because these patients can look toxic and have an aseptic meningitis!)
- Common bugs for infectious colitis that can also cause infectious proctitis: Salmonella, Shigella, Campylobacter, C diff; GNRs
- Sexually transmitted (e.g. Via anal intercourse)
- HSV (esp HSV2)*
- Chlamydia (lymphogranuloma venerum)*
A few clinical pearls on the sexually transmitted causes of proctitis!!
|HSV||? Can also get aseptic meningitis and look very ill!
? Treat with acyclovir
|Syphilis||? Usually syphilitic proctitis is asymptomatic
? Treponema pallidum is tropic to CSF so aseptic meningitis is common! 1/3 of patients with early syphilis have invasion into the CSF (regardless of HIV status)!
? About 1/4 of patients with HIV present with concomitant primary syphilis (chancre) and secondary syphilis (rash) at time of diagnosis
? (more here: http://cid.oxfordjournals.org/content/44/9/1222.full)
|Gonorrhea||? Usually localized (unlikely to see proctitis and meningitis)|
|Chlamydia (LGV)||? Can get aseptic meningitis and look very ill!
? Treat with doxy (also should get a dose of IM CTX)
And, for meningitis:
- In general, studies quote that gram stain for bacterial meningitis is positive 60% of the time, and cultures return positive 90% of the time
- Cultures sterilize by 6 hours after starting antibiotics
- If you are worried about strep pneumo meningitis, give dexamethasone before antibiotics! Not as helpful after antibiotics are already given
- *Steroids can potentially worsen some causes of meningitis (e.g., cause disseminated HSV infection in the case of HSV meningitis)