An anorectal ulcer can be caused by a number of conditions.
Infection:
(1) syphilis
(2) tuberculosis
(3) amebiasis
(4) leishmaniasis
(5) lymphogranuloma venereum
(6) chickenpox
Drugs or chemicals:
(1) ergotamine
(2) nicorandil
(3) rectal suppositories
Other causes:
(1) gastric heterotopia
(2) malignancy
(3) trauma including insertion of an enema nozzle or other foreign body
(4) decubitus
If there is evidence that the ulcer is related to anal intercourse then the patient should be screened for HIV and other sexually-transmitted diseases.
If no cause is identified after an initial assessment, then continue to investigate. Not everyone is comfortable talking about their private habits.
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