A 34-year-old cisgender man who has sex with cisgender men presents with three days of rectal pain and rectal discharge. He denies fever, diarrhea, cramping, or other systemic symptoms. He reports frequent receptive anal intercourse without a condom. Physical examination is unremarkable, but anoscopy shows purulence without significant mucosal erosion. He receives appropriate empiric therapy for acute proctitis with a single intramuscular dose of ceftriaxone 500 mg and oral doxycycline 100 mg twice daily for 7 days. A nucleic acid amplification test (NAAT) on the exudate was subsequently positive for Neisseria gonorrhoeae and negative for Chlamydia trachomatis.