Mechanisms, management and prevention of anorectal sexually transmitted infections.
Reinforcessuggested applicable standard· CDC (Workowski KA, Bachmann LH, Chan PA, et al.), Sexually Transmitted Infections Treatment Guidelines, 2021, Proctitis, Proctocolitis, and Enteritis; MMWR Recommendations and Reports 2021;70(RR-4):1-187
Decision at stakeempiric treatment for acute proctitis in patients with receptive anal exposure
… Give empiric ceftriaxone 500 mg IM once plus doxycycline 100 mg BID for 7 days presumptively while awaiting results, started whenever the presentation is consistent with acute proctitis (anorectal exudate on exam or polymorphonuclear leukocytes on a Gram-stained anorectal smear, or, if anoscopy/Gram stain is unavailable, in a patient reporting receptive anal exposure) rather than only once symptoms are "moderate-severe", then tailor therapy by pathogen (extend doxycycline to the full 21-day course presumptively for LGV when bloody discharge, perianal or mucosal ulcers, or tenesmus accompany a positive rectal chlamydia NAAT, rather than waiting for confirmed LGV; penicillin G benzathine for syphilis, antivirals for HSV). …
From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text.
Our full summary of this standard
In a patient with proctitis symptoms and receptive anal sex history, test with rectal NAAT for gonorrhea and chlamydia (LGV testing if positive), syphilis serology, HSV PCR from ulcers, stool studies for enteric pathogens in proctocolitis, plus HIV and hepatitis testing. Give empiric ceftriaxone 500 mg IM once plus doxycycline 100 mg BID for 7 days presumptively while awaiting results, started whenever the presentation is consistent with acute proctitis (anorectal exudate on exam or polymorphonuclear leukocytes on a Gram-stained anorectal smear, or, if anoscopy/Gram stain is unavailable, in a patient reporting receptive anal exposure) rather than only once symptoms are "moderate-severe", then tailor therapy by pathogen (extend doxycycline to the full 21-day course presumptively for LGV when bloody discharge, perianal or mucosal ulcers, or tenesmus accompany a positive rectal chlamydia NAAT, rather than waiting for confirmed LGV; penicillin G benzathine for syphilis, antivirals for HSV). Include partner notification and treatment, sexual health counseling, and repeat STI testing at 3 months.