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338 Current Essentials of Surgery Proctitis Anusitis, Infectious s Essentials of Diagnosis Proctitis and anusitis are nonspecific terms for varying degrees of inflammation due to infectious or inflammatory diseases; causative agent or event determines symptoms, signs, and appropriate man- agement Herpes proctitis: lesions appear as vesicles, which rupture to form ulcers; ulcers may become secondarily infected; viral culture of vesicle or biopsy of ulcer is diagnostic Anorectal syphilis: chancre is an indurated, nontender perianal ulcer at the site of inoculation; dark-field microscopy of exudate and serologic testing are preferred for diagnosis Gonococcal proctitis: caused by the gram-negative diplococcus Neisseria gonorrhoeae; culture on Thayer-Martin medium reveals gram-negative diplococci; enzyme-linked immunosorbent and DNA probe assays are available Chlamydial proctitis and lymphogranuloma venereum: causative agent is Chlamydia trachomatis; diagnosis is made with the lym- phogranuloma venereum complement fixation test; tissue cul- tures are also used Chancroid: Haemophilus ducreyi causes soft ulcer and local lym- phadenitis; H ducreyi culture on heated blood agar supplemented with factor X is diagnostic s Differential Diagnosis Radiation-induced or ischemic proctitis s Treatment Herpes proctitis: oral acyclovir is the treatment of choice but is not curative Anorectal syphilis: penicillin is treatment of choice Gonococcal proctitis: intramuscular procaine penicillin G and oral probenecid Chlamydial proctitis and lymphogranuloma venereum: tetracy- cline for 21 days Chancroid from H ducreyi: azithromycin, erythromycin, ciprofloxacin, or ceftriaxone Prevention: sexual contacts must be sought, tested, and treated s Pearl Always identify sexual contacts of patients with sexually transmitted diseases.

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