Empirical therapy for the management of acute proctitis in homosexual men
A. M. Rompalo, P. Roberts, K. Johnson and W. E. Stamm
Department of Medicine, Harborview Medical Center, University of Washington School of Medicine, Seattle 98014.
An effective empirical treatment regimen would provide a more rapid and
less expensive approach to the management of homosexual men with acute
proctitis. We conducted a randomized trial in 129 homosexual men who
presented with acute proctitis, comparing treatment with an empirical
regimen (4.8 million U of aqueous penicillin G procaine intramuscularly and
1.0 g of probenecid orally, followed by 100 mg of oral doxycycline twice
daily for seven days) with specific therapy for each infection as it was
recognized. Therapy with the empirical regimen resulted in more rapid
resolution of the symptoms of proctitis, the objective signs of proctitis,
and the infecting microorganisms. However, nearly one fourth of the
patients, primarily those with unrecognized herpes simplex virus proctitis,
did not respond to empirical therapy. We recommend empirical therapy
coupled with appropriate pretreatment diagnostic testing for the initial
management of acute proctitis in homosexual men with no clinical evidence
of acquired immunodeficiency syndrome or AIDS-related complex.