A 56-year-old homosexual man presents with itching, anorectal pain, and tenesmus of 1 week's duration. Rectal examination reveals generalized tenderness without frank prostate abnormalities. Which of the following is most likely?

A) Acute prostatitis
B) External hemorrhoid
C) Proctitis
D) Colon cancer


C) Proctitis

The combination of itching, anorectal pain, and tenesmus in a homosexual man should make one consider proctitis. This may be caused by a sexually transmitted infection such as gonorrhea, chlamydia, or lymphogranuloma venereum. A careful history should be taken, and counseling regarding protection from these diseases should be offered. While pain and itching are associated with hemorrhoids, the internal tenderness on examination makes this less likely than proctitis in this patient. Acute prostatitis does not usually cause itching and is usually associated with examination findings. Most colon cancers do not cause any symptoms, which is why screening for asymptomatic disease is so important.

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