The anorectum is a specialized region of the gastrointestinal tract that performs sensory, storage and elimination functions. The lining is richly endowed with discriminatory nerve endings to allow the body to distinguish between flatus, liquid and solid waste. While sturdy, the surfaces are vulnerable to trauma and infections. With or without an anal or rectal injury, sexually transmitted disease may be the source of considerable morbidity. While symptoms may be found in patients with normal immune systems, they are found in increasing frequency in the immune compromised population. In patients with pre-existing systemic conditions such as AIDS or HIV, common pathogens may take on an even more ominous clinical significance.
The cause of the symptoms may be bacterial or viral. Not uncommonly a sexually transmitted disease (STD) may be involved. STD’s include gonorrhea, chlamydia, herpes, syphilis and cytomegalovirus.
Prior to initiating treatment, a thorough history accompanied by a focused physical examination will usually yield the cause of an anorectal infection in most patients. Laboratory studies are usually confirmatory.
When an infection is suspected, your physician may want to take cultures of the anus or rectum. The collection of anal cultures is painless and is performed in your doctor’s office. If there is a suspicion that the cause of symptoms such as a rectal discharge, anal itching, an anal ulcer or anal pain are secondary to an infection, cultures can be taken from the anal area or of the anal discharge. The culture is taken by placing a cotton swab into the rectum or by placing the cotton tip into any rectal discharge that is present. The cotton tip is placed into a special preservative and transported to a laboratory for identification. Your doctor will receive a report of the laboratory findings in several days. Often the report will include the names of the drugs to which the offending organism is sensitive. This will help your physician begin the correct treatment program.
- Gonorrhea is the most common sexually transmitted infection in the homosexual male. It is caused by Neisseria Gonorrhea. It is often seen in conjunction with a Chlamydia infection.
- Chlamydia trachomatis is the most commonly reported bacterial sexually transmitted disease in the United States. As Chlamydia often coexists with gonorrhea, treatment should be geared towards both infections.
- Syphilis has often been called “the great imitator”, because so many of the signs and symptoms are indistinguishable from those of other diseases. Syphilis is caused by the bacterium Treponema pallidum.
- Herpes Simplex Virus type II is the causative factor in 90% of cases of anal herpes and may be a cofactor in the transmission of HIV, by causing breaks in the anorectal lining.
- Cytomegalovirus also causes ulceration and may be a coexisting factor with other anorectal infections.
- Genital warts and certain anal and cervical cancers are thought to be caused by the human papilloma virus (HPV). Your physician can perform a Pap smear to evaluate the likelihood of an HPV infection. Your physician will place a small brush into the anal opening and rotate the brush several times. This is painless. The brush will be sent to a laboratory for analysis. If you are found to have an HPV infection further diagnostic studies can be performed and treatment can be started.