Document resource
Introduction Inflammatory bowel disease (IBD)-related proctitis can be severe, chronic and resistant to treatment. Sexually transmitted infections (STIs) can also cause proctitis and are an important differential diagnosis in sexually active people. Infective proctitis encompasses a spectrum of disease severity, ranging from acute to chronic and mild to severe rectal inflammation that may go unrecognised and untreated. There are limited data on the prevalence of infective proctitis among patients presenting to outpatient gastroenterology or IBD services.Methods We performed a retrospective review of clinical records for new patients attending IBD clinic with a diagnosis of proctitis at a large teaching hospital between 1 January 2020 – 13 January 2025. Patients were identified using ICD-10 codes for proctitis. Included patients had proctitis confirmed endoscopically and/or histologically. Clinical records were reviewed to determine whether history, examination and investigations explored STIs as a risk factor during the diagnostic process.Results 51 individuals presenting with proctitis were identified, with a median age of 41 years (IQR: 30.5-51 years). 49% of the cohort were male (including one transgender male). Only 5.9% (n=3) had a documented sexual history, and there was no documentation regarding the presence or absence of fever. 21.6% (n=14) underwent HIV testing within 12 months of clinic review. No patients were offered rectal swabs in endoscopy or gastroenterology clinic. There were no cases of documented referral to sexual health services (SHS). Two patients self-presented to SHS, leading to one diagnosis of lymphogranuloma venereum proctitis. During follow-up, 19.6% (n=10) of patients were treated with biologic therapy.Conclusions Assessment for sexually transmitted causes of proctitis in patients presenting to outpatient IBD services was limited, with infrequent documentation of key risk factors and an absence of routine testing for infective aetiologies. Retrospective notes review may not reflect the true frequency of STI assessment, if undocumented. In this cohort, the observed prevalence of infective proctitis was 1.9%; however, as the majority of patients were not screened, the true prevalence in this population remains uncertain. Sexually transmitted proctitis may present identically to IBD-related proctitis and, if unrecognised, can result in unnecessary investigation, prolonged follow-up, and escalation of immunosuppressive therapy. Improved awareness of STI proctitis assessment may facilitate timely diagnosis, appropriate treatment and avoidance of high cost IBD drug use.