Clinical features of HSV proctitis in AIDS
- HSV proctitis is the most common cause of nongonococcal proctitis in sexually active homosexual men.
- HSV proctitis classically presents with tenesmus, purulent rectal discharge, severe proctalgia, fever, constipation, and anorectal bleeding.
- Painful inguinal lymphadenopathy is an almost universal finding. The pain tends to distribute in the region of the sacral roots (i.e., buttocks, perineal region, and posterior thigh).
- Because of the neural involvement by HSV and the presence of severe pain, patients may complain of impotence and difficulty in initiating micturition.
- Visual inspection and anoscopy commonly reveal the following lesions: vesicles, pustular rectal lesions, or diffuse ulcerations.
- HSV is a pathogen of the squamous mucosa; therefore diffuse proctitis involving the entire rectum is rare.
- In severe cases, the columnar rectal and sigmoid mucosa has been involved.
- The differential diagnoses of HSV proctitis include lymphogranuloma venereum ( Chlamydia trachomatis ), Entamoeba histolytica, Salmonella spp., and Campylobacter jejuni .
