The incidence has increased since the mid-1960s, and HPV now accounts for one million patient presentations to colorectal surgeons each year, the highest among STIs. Human papillomavirus (HPV) is the most common STI in the US, with estimates indicating 5.5 million new infections occur every year. Occasionally, a large solitary ulcer is seen. Proctoscopy is painful and reveals friable rectal mucosa with multiple erosions or ulcers in the distal rectum.
They involve the perianal skin and anal canal but may also extend to the rectum. Typical lesions are small vesicles that eventually ulcerate and resolve over a few days. When compared to non-HSV proctitis, HSV proctitis is more commonly associated with the symptoms of anorectal pain, constipation, tenesmus, anal pruritus, difficulty in initiating micturition, sacral paresthesias, posterior thigh pain, fever, and inguinal adenopathy. This trend may have important clinical implications, as HSV type 1 produces less symptomatic recurrences and less viral shedding than HSV type 2. HSV type 1, the causative agent of oral and ocular lesions, is implicated in up to 30% of anogenital lesions, a proportion that appears to be on the rise, reported at 78% in one study among US college students. Forty-five million Americans are infected with HSV type 2, the causative agent of anogenital herpetic infection, with one million new infections occurring each year. Herpes simplex virus (HSV) is a highly prevalent STI in the US.
In proctocolitis, organisms associated with food or waterborne diseases are more common and include Entamoeba histolytica, Campylobacter spp., Salmonella spp., Shigella spp., Cryptosporidium spp., and Cytomegalovirus (CMV). Typical organisms in distal proctitis include Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, and Herpes simplex virus. Two clinical entities can be distinguished based on anatomical involvement and common causative agents: distal proctitis and proctocolitis. Similarly, syphilis is associated with a decrease in CD4 cell counts and an increase in HIV viral load, which both improve after treatment for syphilis. For example, the presence of gonococcal infection increases the infectiousness of HIV, a pattern that reverses following successful gonorrhea treatment. This fact has major implications since coinfection has been shown to alter the natural history of HIV and the response to treatment. In addition, human immunodeficiency virus (HIV) transmission is facilitated by virtually any STI, whether in the presence or absence of ulcerative lesions. When evaluating a patient with an anorectal STI, it is important to remember that coinfection is common and has been reported to be as high as 41% in some high risk populations. Transmission may occur through a variety of sexual practices, such as receptive anal intercourse and oro-anal sexual contact. Common lesions include ulcerations, vegetations, and clinical proctitis. Common complaints of anorectal STIs include anal pain, tenesmus, urgency, purulent drainage, and bleeding. In one study among men who have sex with men (MSM), routine screening found that 85% of rectal infections with chlamydia or gonorrhea were asymptomatic. Symptoms of STIs are often nonspecific and latent, making diagnoses challenging. Although traditionally associated with homosexual men, anal receptive intercourse is in fact more practiced among heterosexual couples in absolute numbers, showing wide geographical, ethnical and cultural variability. The incidence of anorectal STIs has risen in recent years, a trend primarily attributed to an increase in the practice of anal receptive intercourse. This article reviews STIs of the anus and rectum, examining their epidemiology, presentation, and management.Īnorectal STIs are commonly the result of anal receptive intercourse but may also be due to contiguous spread from a genital infection. Patients with anorectal symptoms or lesions are often referred to colorectal surgeons for complete evaluation or management. Anorectal involvement is common, although the exact prevalence remains unknown due to numerous asymptomatic infections and a lack of accurate epidemiologic data. In the United States (US), the annual incidence reaches approximately 15 million cases. Sexually transmitted infections (STIs) are a substantial health concern, with an estimated worldwide incidence of 333 million cases per year.