• Radiation treatment
  • Autoimmune
  • Vasculitis
  • Ischemia
  • Infectious (STI and enteric organisms)

Clinical Features


  • Inflammation of the rectal mucosa
  • Pain on defecation
  • Tenesmus
  • Mucoid discharge
  • Inguinal lymphadenopathy (may be seen with T. pallidum)

By Causative Agent

  • Condyloma Acuminata
  • Gonorrhea
    • Symptoms vary from none to severe rectal pain with yellow, bloody discharge
    • Unlike nonvenereal cryptitis, infection is not confined to the posterior crypt
  • Chlamydia
    • Infection due to direct anorectal infection or via vaginal seeding to perirectal lymphatics
    • Symptoms range from asymptomatic to anal pruritus, pain, purulent discharge
    • Lymphogranulomatous variety
      • Acutely painful anal ulcerations associated with unilateral lymph node enlargement
      • Fever and flulike symptoms
      • May result in rectal scarring, stricturing, perirectal abscesses, chronic fistulas
  • Syphilis
    • Primary
      • Anal chancres appear ~2-6 weeks after intercourse, are often painful
        • May be misdiagnosed as simple fissure
          • Symmetric lesion on opposite side of anal margin is distinguishing feature
          • Inguinal adenopathy is often present
    • Secondary
      • Condylomata lata (flatter and firmer than condylomata acuminata)
  • Herpes Simplex Virus-2
    • Itching and soreness in perianal area progressing to severe anorectal pain
      • Accompanied by flulike illness, inguinal adenopathy
    • Early lesions are small, discrete vesicles on erythematous base
      • Vesicles then enlarge, coalesce, and rupture, forming exquisitely tender ulcers

Differential Diagnosis

Anorectal Disorders


  • Consider Gram stain and culture


Presumed GC/chlamydia of cervix, urethra, or rectum (uncomplicated)[1]

Typically, treatment for both gonorrhea and chlamydia is indicated, if one entity is suspected.


  • Gonorrhea
    • Ceftriaxone IM x 1
      • 500 mg, if weight <150 kg
      • 1 g, if weight ≥150 kg
  • Chlamydia

Ceftriaxone contraindicated

^Additional chlamydia coverage only needed if treated with cefixime only

Partner Treatment


  • Penicillin G 2.4mil IM x1

Herpes Simplex Virus-2

  • Acyclovir 400mg PO TID x10d for initial episode; 800mg TID x2d for recurrent episodes

See Also

  • Anorectal Disorders


  1. Cyr SS et al. Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR. Center for Disease Control and Prevention. 2020. 69(50):1911-1916
This article is issued from Wikem. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.