Proctitis with anorectal pain, pruritus, tenesmus, discharge or bleeding in anorectal infection from gonorrhea, Chlamydia, lymphogranuloma venereum; ulcerations in herpes simplex, chancre in primary syphilis. May arise from receptive anal intercourse. Itching in younger patients from pinworms.

Genital warts from human papillomavirus, condylomata lata in secondary syphilis. Anal fissures in proctitis, Crohn's disease men, review the pattern of urination (see pp. - ). Does the patient lave any difficulty starting the urine stream or holding back urine? Is the low weak? What about frequent urination, especially at night? Or pain or urning as urine is passed? Any blood in the urine or semen or pain with ^ejaculation? Is there frequent pain or stiffness in the lower back, hips, or upper thighs?

These symptoms suggest urethral obstruction as in benign prostatic hyperplasia or prostate cancer, especially in men older than age 70.

Also in men, is there any feeling of discomfort or heaviness in the prostate Suggests possible prostatitis area at the base of the penis? Any associated malaise, fever, or chills?

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