Rectal Gonorrhea in Men: Diagnosis and Treatment

Abstract

Of 1262 male patients studied on the basis of rectal symptoms, gonorrhea contact or a previously positive rectal culture for Neisseria gonorrhoeae 554 (44%) had rectal gonorrhea, based on a positive culture; in these patients the symptom of mucus on the stool and the anoscopic finding of generalized exudate proved significant but of low specificity when compared with symptoms and findings in culture-negative patients. Patients were treated with 4.8 million units of procaine penicillin with 1 g probenecid, 3.5 or 4.5 g of ampicillin with 1 g probenecid or 9.5 g of tetracycline given over 4 days. Of the patients with rectal gonorrhea, 407 returned for test of cure. Failure rates were 5% with each of the first 3 regimens and 15% with tetracycline (P < 0.01). Procaine penicillin with probenecid is recommended as the treatment of choice, with tetracycline being reserved for penicillin-allergic patients.