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 .