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International Journal of Cancer May 2024The International Anal Neoplasia Society (IANS) developed consensus guidelines to inform anal cancer screening use among various high-risk groups. Anal cancer incidence...
The International Anal Neoplasia Society (IANS) developed consensus guidelines to inform anal cancer screening use among various high-risk groups. Anal cancer incidence estimates by age among risk groups provided the basis to identify risk thresholds to recommend screening. Guided by risk thresholds, screening initiation at age 35 years was recommended for men who have sex with men (MSM) and transgender women (TW) with HIV. For other people with HIV and MSM and TW not with HIV, screening initiation at age 45 years was recommended. For solid organ transplant recipients, screening initiation beginning from 10 years post-transplant was recommended. For persons with a history of vulvar precancer or cancer, screening initiation was recommended starting within 1 year of diagnosis of vulvar precancer or cancer. Persons aged ≥45 years with a history of cervical/vaginal HSIL or cancer, perianal warts, persistent (>1 year) cervical HPV16, or autoimmune conditions could be considered for screening with shared decision-making, provided there is adequate capacity to perform diagnostic procedures (high-resolution anoscopy [HRA]). Anal cytology, high-risk (hr) human papillomavirus (HPV) testing (including genotyping for HPV16), and hrHPV-cytology co-testing are different strategies currently used for anal cancer screening that show acceptable performance. Thresholds for referral for HRA or follow-up screening tests are delineated. These recommendations from IANS provide the basis to inform management of abnormal screening results, considering currently available screening tools. These guidelines provide a pivotal foundation to help generate consensus among providers and inform the introduction and implementation of risk-targeted screening for anal cancer prevention.
Topics: Male; Humans; Female; Adult; Middle Aged; Homosexuality, Male; Papillomavirus Infections; Early Detection of Cancer; Sexual and Gender Minorities; Anus Neoplasms; Human papillomavirus 16; HIV Infections; Papillomaviridae
PubMed: 38297406
DOI: 10.1002/ijc.34850 -
Molecular Aspects of Medicine Dec 2023Human papillomavirus (HPV) infection represents a significant global health concern owing to its role in the etiology of conditions ranging from benign low-grade lesions... (Review)
Review
Human papillomavirus (HPV) infection represents a significant global health concern owing to its role in the etiology of conditions ranging from benign low-grade lesions to cancers of the cervix, head and neck, anus, vagina, vulva, and penis. Prophylactic vaccination programs, primarily targeting adolescent girls, have achieved dramatic reductions in rates of HPV infection and cervical cancer in recent years. However, there is a clear demand for a strategy to manage the needs of the many people who are already living with persistent HPV infection and/or HPV-associated conditions. Unlike prophylactic vaccines, which act to prevent HPV infection, therapeutic vaccination presents an opportunity to induce cellular immunity against established HPV infections and lesions and prevent progression to cancer. Several HPV vaccines are undergoing clinical development, using a range of platforms. Peptide- or protein-based vaccines, vector-based vaccines, whole-cell vaccines, and nucleic acid vaccines each offer relative merits and limitations for the delivery of HPV antigens and the subsequent generation of targeted immune responses. There has been particular interest in DNA-based vaccines, which elicit both cellular and humoral immune responses to provide long-lasting immunity. DNA vaccines offer several practical advantages over other vaccine platforms, including the potential for rapid and scalable manufacturing, targeting of many different antigens, and potential for repeat boosting. Furthermore, unlike vectored approaches, DNA vaccines are thermostable over extended time periods, which may enable shipping and storage. Several delivery strategies are available to address the main challenge of DNA vaccines, namely their relatively low transfection efficiency. We review the latest clinical data supporting the development of DNA vaccines and reflect on this exciting prospect in the management of HPV-related disease.
Topics: Male; Female; Adolescent; Humans; Papillomavirus Infections; Vaccines, DNA; Uterine Cervical Neoplasms; Papillomavirus Vaccines; Human Papillomavirus Viruses
PubMed: 37931422
DOI: 10.1016/j.mam.2023.101224 -
Journal of Medical Ultrasonics (2001) Jul 2023In inflammatory bowel disease, including Crohn's disease and ulcerative colitis, an excessive immune response due primarily to T-cell lymphocytes causes inflammation in... (Review)
Review
In inflammatory bowel disease, including Crohn's disease and ulcerative colitis, an excessive immune response due primarily to T-cell lymphocytes causes inflammation in the gastrointestinal tract. Lesions in Crohn's disease can occur anywhere in the gastrointestinal tract, i.e., from the oral cavity to the anus. Endoscopically, aphthoid lesions/ulcers believed to be initial lesions progress to discrete ulcers, which coalesce to form a longitudinal array and progress to longitudinal ulcers with a cobblestone appearance, which is a typical endoscopic finding. Before long, complications such as strictures, fistulas, and abscesses form. Lesions in ulcerative colitis generally extend continuously from the rectum and diffusely from a portion of the colon to the entire colon. Endoscopically, lack of vascular pattern, fine granular mucosa, erythema, aphthae, and small yellowish spots are seen in mild cases; coarse mucosa, erosions, small ulcers, bleeding (contact bleeding), and adhesion of mucous, bloody, and purulent discharge in moderate cases; and widespread ulcers and marked spontaneous bleeding in severe cases.
Topics: Humans; Colitis, Ulcerative; Crohn Disease; Ulcer; Inflammatory Bowel Diseases
PubMed: 36036332
DOI: 10.1007/s10396-022-01250-2 -
Cureus Aug 2023Gonorrhoea is an infection caused by bacteria that has recently been detected in humans and typically spreads through sexual contact. It leads to significant health... (Review)
Review
Gonorrhoea is an infection caused by bacteria that has recently been detected in humans and typically spreads through sexual contact. It leads to significant health issues in both prosperous and impoverished countries, culminating in significant yearly expenditures for diagnosis and treatment. Young adults who are involved in unprotected sexual activity and are promiscuous are particularly susceptible to gonorrhoea. It has been estimated that approximately 86.95 million individuals globally acquire the virus each year. Gonorrhoea has been reported to affect a variety of body parts, including the cervix in women and the urethra in males, as well as other areas such as the eyes, anus, throat, and, on rare occasions, the joints. It is momentarily the second most frequently reported sexually transmitted disease (STD) by the Centers for Disease Control and Prevention (CDC), trailing only chlamydia. Since the early 2000s, gonorrhoea cases have been on the rise globally, especially across many European nations, with an elevated prevalence among populations at higher risk of getting sexually transmitted infections (STIs), such as men who have sex with men and young heterosexual individuals. The fundamental objectives of gonorrhoea management techniques are to prevent, identify, and cure infections in patients and their partners in addition to minimizing the disease's stigma. It additionally involves monitoring antibiotic resistance and treatment failures, and it also involves advocating appropriate antimicrobial medication usage and stewardship.
PubMed: 37711920
DOI: 10.7759/cureus.43464 -
The Surgical Clinics of North America Jun 2024Hemorrhoids and anal fissures are two of the most common benign anorectal diseases. Despite their high prevalence, diagnostic accuracy of benign anorectal disease is... (Review)
Review
Hemorrhoids and anal fissures are two of the most common benign anorectal diseases. Despite their high prevalence, diagnostic accuracy of benign anorectal disease is suboptimal at 70% for surgeons, especially for hemorrhoidal diseases. Once the diagnosis is correctly made, numerous medical and surgical treatment options are available, each with different rates of success and complications. In this article, the authors review each step of patient management, with emphasis on evidence-based treatment options for hemorrhoids and anal fissures. The article discusses the pathophysiology, diagnosis, medical management, and procedures for hemorrhoids followed by a detailed overview on the management of anal fissures.
Topics: Hemorrhoids; Humans; Fissure in Ano; Hemorrhoidectomy
PubMed: 38677814
DOI: 10.1016/j.suc.2023.11.001 -
Ugeskrift For Laeger May 2024
Topics: Humans; Condylomata Acuminata; Male; Female; Anus Neoplasms
PubMed: 38847314
DOI: 10.61409/V72029 -
Nature Reviews. Gastroenterology &... Jun 2024The ability to experience pleasurable sexual activity is important for human health. Receptive anal intercourse (RAI) is a common, though frequently stigmatized,... (Review)
Review
The ability to experience pleasurable sexual activity is important for human health. Receptive anal intercourse (RAI) is a common, though frequently stigmatized, pleasurable sexual activity. Little is known about how diseases of the colon, rectum, and anus and their treatments affect RAI. Engaging in RAI with gastrointestinal disease can be difficult due to the unpredictability of symptoms and treatment-related toxic effects. Patients might experience sphincter hypertonicity, gastrointestinal symptom-specific anxiety, altered pelvic blood flow from structural disorders, decreased sensation from cancer-directed therapies or body image issues from stoma creation. These can result in problematic RAI - encompassing anodyspareunia (painful RAI), arousal dysfunction, orgasm dysfunction and decreased sexual desire. Therapeutic strategies for problematic RAI in patients living with gastrointestinal diseases and/or treatment-related dysfunction include pelvic floor muscle strengthening and stretching, psychological interventions, and restorative devices. Providing health-care professionals with a framework to discuss pleasurable RAI and diagnose problematic RAI can help improve patient outcomes. Normalizing RAI, affirming pleasure from RAI and acknowledging that the gastrointestinal system is involved in sexual pleasure, sexual function and sexual health will help transform the scientific paradigm of sexual health to one that is more just and equitable.
Topics: Humans; Rectal Diseases; Colonic Diseases; Sexual Behavior; Anus Diseases; Pleasure; Sexual Dysfunction, Physiological
PubMed: 38763974
DOI: 10.1038/s41575-024-00932-1 -
Journal of Gastrointestinal Surgery :... Dec 2023Understanding anorectal and pelvic floor anatomy can be challenging but is paramount for every physician managing patients with anorectal pathology. Knowledge of... (Review)
Review
Understanding anorectal and pelvic floor anatomy can be challenging but is paramount for every physician managing patients with anorectal pathology. Knowledge of anorectal anatomy is essential for managing benign, malignant, traumatic, and infectious diseases affecting the anorectum. This quiz is intended to provide a practical teaching guide for medical students, medical and surgical residents, and may serve as a review for practicing general surgeons and specialists.
Topics: Humans; Rectum; Pelvic Floor; Anal Canal
PubMed: 38135807
DOI: 10.1007/s11605-023-05862-y