Chlamydia trachomatis proctitis

Chlamydial proctitis occurs commonly in homosexual men and heterosexual women. Clinical manifestations range from asymptomatic to severe, acute proctitis manifested by rectal pain, mucopurulent discharge, hematochezia, abdominal pain, and diarrhea or loose stools. Patients infected with strains of the L₂ immunotype manifested severe proctitis clinically and sigmoidoscopically, and on histopathologic examination had findings consistent with Crohn's disease. Non-LGV immunotypes were associated with milder or no symptoms and with less marked findings on physical examination. However, most asymptomatic patients were found to have fecal leukocytes on rectal gram stain and those from whom biopsies were obtained had an inflammatory infiltrate in the lamina propria on histologic examination. Tetracycline eradicated C. trachomatis rectal infection, and was associated with resolution of symptoms and elimination of fecal leukocytes. Further studies to determine the mode of spread, infectivity, optimal treatment, immune response, and long-term sequelae of rectal infection with C. trachomatis are warranted.