Introduction:
With recent lymphogranuloma veneruem (LGV) and Shigella outbreaks amongst men-who-have-sex-with-men (MSM), proctitis has become a prominent clinical issue. There is no UK guideline regarding proctitis management but guidance is available from IUSTI and CDC.

Objectives:
To review our proctitis cases and generate a clinic policy to standardise practice.

Methods:
Casenotes coded C4NR between 01/01/14-31/12/15 were reviewed with data collated and analysed via Microsoft Excel.

Results:
100 care episodes were reviewed (92 patients, 6 attended twice and 1 thrice).  All patients were male; 83 homosexual, 8 bisexual and 1 heterosexual.  67 patients were White British, 31 were HIV positive. Median age was 29 years (range=18-62).  
Presenting symptoms were varied with rectal pain (58), discharge (54), and bleeding (44) most common. Proctoscopy in 82 cases found varying signs (32 discharge, 24 oedema, 25 contact bleeding, 10 ulceration). Microscopy was diagnostic of proctitis in 39/84 (46.4%) patients. Physician-requested investigations were:

                                                Test	Performed	Positive results
Chlamydia trachomatis TMA	100	                         14 (including 6 LGV)
Neisseria gonorrhoea TMA	100	                         28
Gonococcal culture	                 98	                         24
Herpes Simplex PCR	         30	                         9
Treponema pallidum PCR	 27	                         1
Treponemal serology	         93	                         5
Stool culture	                         13	                         4

Treatment at initial visit was predominantly doxycycline-based (99/100), with course length varying from 7-21 days. Concurrent therapies were influenced by clinical findings and reported contacts; predominantly ceftriaxone (53), azithromycin (31), and aciclovir (19).  

Conclusions:
Gonorrhoea incidence was high (28%), as was herpes when requested (30%). Updated clinic policy for all proctitis patients includes requesting Herpes Simplex PCR and presumptive treatment for gonorrhoea.

A review of sexually acquired proctitis: an array of symptoms, investigations and treatments