0071643192.pdf

ABDOMINAL AND GASTROINTESTINAL

EMERGENCIES

FIGURE 11.6. Perianal condylomata acuminata.

(Reproduced, with permission, from Gonzales R, Zeiger R (online eds.) Current Medical
Diagnosis & Treatment2008. Online edition. New York. McGraw-Hill, 2008.
http://www.accessmedicine.com. April 2008.)

TABLE 11.10. STDs That Cause Proctitis

SYMPTOMS/DIAGNOSIS TREATMENT COMPLICATIONS

Condyloma Perianal soft fleshy growths Chemotherapy or definitive 40% recurrence associated with

acuminata (HPV) See Figure 11.6; may spread therapy (ablation, squamous cell carcinoma

from vagina/scrotum cryotherapy, etc.)

Anoscopy to check for

intranal disease

Gonorrhea Asymptomatic to rectal pain Ceftriaxone Dissemination to heart, liver, CNS, joints

and discharge. Gram stain/

cultures for diagnosis.

Chlamydia Asymptomatic to rectal pain Azithromycin, doxycycline: Rectal scarring, abscesses, fistulas

and discharge; ulcerations 21-day course for LGV

Gram stain/cultures, ELISA, chlamydia

direct immunofluorescence,

PCR assays for diagnosis

Syphilis Primary: Chancre in the anus Penicillin Good prognosis if treated

may be painful

Secondary: Perianal

condyloma lata

Chancroid Multiple painful bleeding Azithromycin

lesions with indurated, Ceftriaxone

draining lymph nodes Fluoroquinolones

Herpes Pruritus, pain Analgesic Recurrent bouts

Discrete vesicles on Stool softener Constipation common

erythematous base Acyclovir

progressing to ulcers