Proctitis
Usual PathogensPolymicrobial
N. gonorrhoeae
C. trachomatis (including serovars causing lymphogranuloma venereum)
Syphilis
Herpes simplex virus (HSV)
Diagnosis:
- rectal swabs for NAAT for C. trachomatis and N. gonorrhoeae
- PCR for HSV
- serology for syphilis/HIV
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Ceftriaxone | 250mg IM | 1 dose |
| + | ||
| Doxycycline | 100mg PO bid | 7 days |
Lymphogranuloma venereum (LGV)
- Increasing incidence of LGV proctitis in men who have sex with men.
See LGV
Herpes simplex virus (HSV)
- No role for topical acyclovir.
Primary episode, Severe
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Acyclovir | 5mg/kg IV q8h | Switch to oral agents when clinical improvement to complete course of therapy |
Primary episode, Mild-moderate
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Valacyclovir | 1g PO bid | 7-10 days |
| or | ||
| Famciclovir | 250mg PO tid | 5-7 days |
| or | ||
| Acyclovir | 400mg PO tid | 7-10 days |
Recurrent
See Genital Herpes - recurrent