Proctitis - streptococcal

Definition:

Streptococcal proctitis is an inflammation of the anus and rectum caused by Streptococcus bacteria.

Alternative Names:

Streptococcal proctitis; Perianal streptococcal cellulitis

Causes, incidence, and risk factors:

Streptococcal proctitis is usually a disease of children and often occurs in conjunction with a "strep throat" (streptococcal pharyngitis) or nasopharyngitis. Children are thought to inoculate the skin around the anus while cleaning the area after using the toilet or by scratching with hands contaminated by secretions from their mouth or nose.

Symptoms include an expanding area of redness around the anus, complaints of itching and pain and, on occasion, pain with bowel movements. Fever may be present.

Symptoms:

History of present or recent "strep throat" or other streptococcal infection, such as a streptococcal skin infection (impetigo)
Redness around the anus
Complaints of perianal discomfort
Discomfort or bleeding with bowel movements

Signs and tests:

Throat culture (positive for Beta hemolytic streptococcus, group A)
Culture, rectal swab (positive for Beta hemolytic streptococcus, group A)

Treatment:

The infection is treated with antibiotics for roughly 10 days, depending on the rate of response. Penicillin is the most frequently used antibiotic in children who are not allergic. Topical treatment with mupirocin may be used in conjunction with other antibiotics, but should not be used as the only treatment.

Expectations (prognosis):

Rapid recovery is expected with antibiotic treatment. It is important to contact your health care provider if recovery does not occur rapidly on antibiotics.

Complications:

Acute glomerulonephritis (kidney disease)
Necrotizing fasciitis (severe skin and soft tissue infection)
Bleeding, discharge
Bloodstream or other streptococcal infections (including heart, joint, bone, and others)
Anal scarring, fistula, or abscess formation

Calling your health care provider:

Call your health care provider if your child complains of pain in the rectal area, painful bowel movements, or other symptoms of streptococcal proctitis.

If your child is receiving antibiotics for streptococcal proctitis, and the area of redness is expanding, or the discomfort or fever are increasing, then call your health care provider immediately. Your health care provider can help answer other questions that you might have about streptococcal proctitis.

Prevention:

Completion of a full course of antibiotic treatment for pharyngeal and other infections with Streptococcus bacteria is effective in eliminating the bacteria from the affected site. Careful handwashing is helpful in preventing this and other infections that result from bacteria carried in the nose and throat.

Review Date: 1/25/2002
Reviewed By: Adam Ratner, M.D., Children's Hospital of Philadelphia, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

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