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Proctitis with Ulceration Workup — SCE Infectious Diseases MCQ

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ModerateSTIsProctitis with Ulceration WorkupSCE Infectious Diseases

A 25-year-old woman presents with acute proctitis. She is MSM-identifying and reports receptive anal intercourse. Rectal NAAT is positive for Neisseria gonorrhoeae. She also has concurrent perianal ulceration. What additional STI testing is essential given the ulceration?

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Correct answer: E — Syphilis serology (RPR/TPHA) plus HSV PCR from the ulcer — perianal ulceration with gonorrhoeal proctitis warrants full GUD workup including syphilis and herpes

Perianal ulceration in the context of proctitis requires a comprehensive genital ulcer disease (GUD) workup. Gonorrhoeal proctitis causes mucosal inflammation but typically does NOT cause external ulceration. The perianal ulcers suggest a co-existing infection: HSV (most common cause of genital/perianal ulceration), syphilis (chancre), or LGV. Full testing should include: HSV PCR from the ulcer base, syphilis serology (RPR/TPHA) plus dark-field microscopy if available, and Chlamydia NAAT with LGV typing. Multiple concurrent STIs are common — comprehensive testing is a BASHH core principle.

Reference: BASHH 2019 – Genital ulcer guidelines; BASHH 2024 – Proctitis