Episode 418 – #IDLove – Colitis

A 21-year-old man presented with a five-day history of rectal pain, tenesmus, and non-bloody diarrhea. Initial clinical reasoning focused on distinguishing between infectious proctitis and inflammatory bowel disease, particularly given the patient's recent travel to Colombia involving street food consumption and freshwater swimming. While initial differentials included parasitic infections like *Entamoeba histolytica* and various bacterial pathogens, the diagnostic workup shifted toward sexually transmitted infections despite the patient's reported low-risk sexual history. Subsequent testing confirmed gonorrheal proctitis, highlighting the necessity of maintaining a broad differential diagnosis and the importance of considering STIs in young adults presenting with proctitis, even when initial patient histories suggest otherwise. This case underscores the clinical value of systematic diagnostic approaches in evaluating acute gastrointestinal symptoms in returning travelers.