Pathogenesis (development of disease)
Pathogenesis depends on the cause of the disease. Proctitis may be secondary, for example, to infectious enteritis (inflammation of the bowel), or it may occur in patients with inflammatory bowel diseases such as ulcerative colitis or Crohn’s disease. In the majority of cases, proctitis results from a sexually transmitted infectious disease (unprotected anal intercourse). Depending on the pathogen, the rectal mucosa reacts with different changes, e.g., mucosal erythema (redness of the mucosa), hemorrhages (bleeding), or ulcerative (ulcer-forming) lesions. The causative agents can be bacterial, viral, and parasitic.
Etiology (causes)
Behavioral causes
- Unprotected anal intercourse/anal sex
- Promiscuity (frequently changing sexual partners)
Causes related to disease
- Allergic reactions – allergic exanthema (rash), for example, to ingredients of suppositories (suppositories), condoms (latex allergy), lubricants.
- Chronic inflammatory bowel disease:
- Ulcerative colitis – chronic inflammatory disease of the mucosa of the colon (large intestine) or rectum (rectum).
- Crohn’s disease – chronic inflammatory bowel disease; it usually progresses in episodes and can affect the entire digestive tract; characteristic is the segmental affection of the intestinal mucosa (intestinal mucosa), that is, several intestinal sections may be affected, which are separated from each other by healthy sections
- Infectious diseases, mainly sexually transmitted diseases (English STD (sexually transmitted diseases) or STI (sexually transmitted infections)).
- AIDS – non-healing and weeping inflammation in the anal area.
- Chlamydia (common: in about 20% of cases).
- Gonorrhea (gonorrhea; Neisseria gonorrhoeae (gonococci)) – purulent proctitis.
- Granuloma inguinale (granuloma venereum; donovanosis) – tropical disease; disease caused by the bacterium Calmmatobacterium granulomatis.
- Genital herpes (genital herpes; HSV-2).
- HPV infection (human papillomavirus)
- Lymphogranuloma inguinale (Chlamydia trachomatis) – associated with fistulas and strictures.
- Syphilis
- Primary stage (Lues I): begins as a papule (coarse millet-sized nodule); from this develops the ulcus durum (German: Harter Schanker, obsolete also Chanker); this has a sharp set-off wall-like edge and a slightly sunken center.
- Secondary stage (Lues II): coarse, very pathogen-rich papules.
- Tertiary stage (Lues III): nodules
- Ulcus molle (“soft chancre”) – painful and soft ulcers (ulcers).
- Infectious enteritis (inflammation of the intestine).
- Campylobacter enteritis
- Salmonella enteritis
- Shigellosis – infectious diarrhea (diarrhea) caused by shigella.
Other causes
- Radiatio (radiotherapy)
- Toxic reactions
- Trauma (injury) from, for example, objects inserted into the anus during sexual intercourse
