People at risk:
(1) men who have sex with men (MSM)
(2) women practicing receptive anal intercourse
(3) women with endocervical gonorrhea (with spread via toilet paper)
(4) sexual partner with gonorrhea
Clinical findings may range from asymptomatic to symptomatic proctitis with:
(1) anal pruritis
(2) tenesmus
(3) purulent anal discharge
(4) rectal bleeding
Anoscopy can help determine the severity and extent of infection.
Anorectal culture of Neisseria gonorrhoeae will support the diagnosis but may be negative. A patient may be diagnosed based on clinical findings if Neisseria gonorrhoeae is identified elsewhere. Nucleic acid amplification is the most sensitive technigue for identifying the bacteria but inhibitors may be present in stool.
Differential diagnosis (and potentially mixed with a gonococcal infection):
(1) Herpes simplex virus (HSV)
(2) Chlamydia trachomatis
(3) syphilis
(4) anal HPV with condyloma
