Gonorrhoea - generally asymptomatic (84%), but can cause pruritis ani, constipation, mucopurulent anal discharge, rectal pain and tenesmus. Treat for both gonorrhoea and chlamydia.
Chlamydia - generally asymptomatic, but can cause pruritis ani, mucus discharge, anal pain
Lymphogranuloma venereum (invasive chlamydia) - generalised illness, with fever, malaise, anal symptoms including purulent/bloody discharge, and anal pain which can mimic IBD
Syphilis - primary 2-10 weeks post-exposure (anorectal chancre which is commonly asymptomatic) and secondary (ulcers and mucous patches, perianal condylomata, generalised manifestations including rash, fever and lymphadenopathy)
HSV - vesicular lesions, severe pain, and tenesmus, difficulty with bowel movements, generalised malaise, fever and lymphadenopathy. Treat with antivirals for 7-10 days.
Colitis - think those pathogens which cause colonic invasion (shigella, salmonella, campylobacter)
CMV (immunocompromised patient)
Radiation
Acute
Hydration, anti-diarrhoeals, sodium butyrate enemas for three weeks
Chronic
Treatment depends on symptoms
Pain/tenesmus - sucralfate enemas BD (dissolve 2g sucralfate in 50ml warm water in a toomey syringe, then either put it directly into rectum or gently place a rectal tube into vault and flush it through)
Mild obstructive symptoms - stool softeners, can try dilating any strictures
Bleeding
Trial sucralfate enemas for four weeks (see above)
APC as second line or if severe bleeding
Formalin not recommended
Intractible symptoms - surgery
Medication-induced
NSAID
Ischaemic
Diversion proctitis
Food protein-induced proctitis - in infants
Eosinophilic proctitis - affects only children younger than 2
