Anoscopy is only to be performed by a medical officer who has undertaken clinical training in anoscopy.
Patients reporting symptoms of proctitis are offered appropriate testing and treatment.
Symptoms of proctitis are
- anal pain
- anal mucopurulent discharge and bleeding
- tenesmus or the feeling of incomplete rectal emptying
- altered bowel habit e.g. constipation, diarrhoea
Specimens should always be collected by the clinician as the patient should be examined. Ideally this should be done using an anoscope. If patients are reluctant to undergo anorectal examination the importance and benefits of physical examination should be explained with respect to achieving an accurate diagnosis and appropriate management plan. If there is no clinician able to do anoscopy, external anal examination and blind swab collection can be done.
Specimen or test Consideration Gram stain Anoscopy-collected mucopus Anal swab for nucleic acid amplification test (NAAT):
Consider M. genitalium
If the chlamydia NAAT test is positive, send the sample for testing for lymphogranuloma venereum (LGV). Note ‘proctitis’ on laboratory request form and specifically request LGV test.
Consider if the patient is a known contact of someone with M. genitalium
Anal swab for N. gonorrhoeae culture Anal swab for herpes NAAT Add if internal or external ulcers are present or severe proctitis Anal swab for Treponema pallidum NAAT and blood for syphilis serology For syphilis if ano-rectal ulceration present Stool specimen Consider if diarrhoea or abdominal pain is a feature
Syndromic treatment of proctitis Doxycycline 100mg orally twice daily for 7 days; if LGV has not been excluded continue for a total of 21 days
ceftriaxone 500mg in 2 mL of 1% lignocaine, intramuscularly, stat
valaciclovir 500mg orally twice daily for 5–10 days
Review at 3–7 days to ensure symptoms have resolved.
All patient consultations including examinations and tests collected are to be documented on the patient’s medical record.
- References and further reading