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GUM AND THE ANUS Ben Goorney Salford Primary Care Trust

GUM AND THE ANUS Ben Goorney Salford Primary Care Trust. “Antrum Amoris”. Overview of Anorectal STI’s. Basic STI concepts Clinical presentation of anorectal STI,s Common anorectal HIV manifestations. Key aspects of HIV testing /sexual history. Basic STI Concepts.

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GUM AND THE ANUS Ben Goorney Salford Primary Care Trust

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  1. GUM AND THE ANUSBen GoorneySalford Primary Care Trust

  2. “Antrum Amoris”

  3. Overview of Anorectal STI’s • Basic STI concepts • Clinical presentation of anorectal STI,s • Common anorectal HIV manifestations. • Key aspects of HIV testing /sexual history

  4. Basic STI Concepts • Asymptomatic nature of anogenital STI,s ie rectal GC • Multiple STI co-exist ie GC/Chlamydia need for full STI screening. • Importance of sexual partner in infection/re-infection cycle. • Secondary/contiguous spread to anorectum.

  5. Main Clinical Presentations • Proctitis- Gonorrhoea, Chlamydia, • Non-specific, Lymphogranuloma venereum(LGV) • Ulceration- Primary syphilis, herpes, tropical bubos.(Chancroid/g.Inguinale/LGV) • Lumps/swellings- Anogenital warts(Condylomata accuminata), • Condylomata Lata of secondary syphilis.

  6. Lymphogranuloma Venereum(LGV) • Re-emergance of old disease (tropical bubos) since 2003. • >500 Cases reported in UK due to L2 Chlamydia serovars. • “Anorectal syndrome” in MSM,often HIV pos.(85%) • Main misdiagnosis is I.B.D esp Crohns disease • Responsive to prolonged course of oral antibiotics

  7. Tropical Bubos(G.Ing/Chancroid)

  8. Early(secondary) Syphilis

  9. Main Components of Sexual History • Sexuality- Gay ,Straight, Bi? • Type of Sex- Active/passive, Both. Use of Sex toys/fisting • No of partners last 3/12. Casual/regular. • Condom usage • Recent travel abroad to high risk areas.

  10. Anorectal Manifestations of HIV • Infective: • Enteropathogens-ie Salmonella/shigella • Opportunistic - Cryptosporidiosis,CMV,atypical Mycobacteria. • Opportunistic Tumours: • Kaposis sarcoma, Non-hodgkins Lymphoma.

  11. Cryptosporidiosis

  12. CMV Disease

  13. Kaposis Sarcoma

  14. HIV Testing Issues • HIV now regarded as “manageable condition” Due to success of HAART • The imperative is now for earlier diagnosis and treatment. • Consider HIV testing (consented) if clinically indicated. • Liase with local GUM service re testing and support.

  15. “Canal Street”- Manchester

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