Thank you to Michelle for presenting the case of a young man presenting with symptomatic anemia found to have chlamydia proctitis and a positive RPR.
- The diagnostic test of choice for chlamydial infection of the genitourinary tract is nucleic acid amplification testing (NAAT) of vaginal swabs for women or urine for men. Many laboratories have also validated NAAT on rectal swabs to diagnose chlamydial proctitis
- CDC recommended regimen for treatment of chlamydia proctitis is CTX 250 mg IM x1 PLUS Doxycyline 100 mg PO x 7 days
- In high risk patients diagnosed with chlamydia proctitis it is important to treat them for gonorrhea b/c of the risk of co-infections (hence the dual coverage above).
- Patients with severe proctitis may have lymphogranuloma venereum (LGV) which requires a full 3 weeks of therapy. See more info on LGV from prior blogs!
- As in this case, if the timing of syphilis is not known, late latent syphilis is presumed. Penicillin G IM once weekly for 3 weeks is the treatment of choice.
Inflammation of the lining of the rectum within 10-12 cm of the dentate line.
- Most commonly gonorrhea or chlamydia (including LGV strains with rq longer duration of therpay)
- Other causes include HSV (more common in immunosuppressed patients), syphilis (usually secondary), C. difficile or parasites (amebiasis).
- Crohn’s disease and Ulcerative colitis
# Radiation or Chemical
Review of Syphilis and Therapy can be found in table form here.
See prior blog from the amazing Grant Smith for more on LGV