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Postgraduate Medicine Nov 1995Hemorrhoids are a common source of anorectal symptoms, which are determined by their size. A helpful measure in small hemorrhoids is a high-fiber diet; in moderate... (Review)
Review
Hemorrhoids are a common source of anorectal symptoms, which are determined by their size. A helpful measure in small hemorrhoids is a high-fiber diet; in moderate lesions, ligature therapy is effective. Surgery should be reserved for large hemorrhoids. Anal fissures, probably caused by trauma to the anal canal during defecation, may persist because of a cycle of hard stools, pain, and reflex spasm. A high-fiber diet and sitz baths relieve acute fissures. Lateral partial internal sphincterotomy is usually effective when they become chronic. Perianal abscess is often caused by acute infection of the anal glands; fistula is the result of chronic infection. Swelling and induration may be present. Pain is throbbing and continuous, and perianal examination may require use of an anesthetic. Incision and drainage with follow-up to ensure resolution of infection is required. Pruritus ani may result from several contributing conditions or may be idiopathic. Restoration of dry, intact perianal skin is the treatment goal. Patients should be taught gentle hygiene and drying methods and advised to avoid caffeine or other dietary items that seem to exacerbate symptoms. Condylomata acuminata cause bleeding and pain if allowed to progress. Biopsy should be considered in patients at risk of dysplasia. Repeated application of caustic topical agents may help small lesions. Large, extensive, and persistent lesions require surgical ablation.
Topics: Abscess; Anus Diseases; Condylomata Acuminata; Hemorrhoids; Humans
PubMed: 7479460
DOI: No ID Found -
Human Pathology Feb 2024Anorectal ulcer with granulation tissue is typically associated with left-sided inflammatory bowel disease or infection. Due to emerging cases of Chlamydia proctitis, we...
Anorectal ulcer with granulation tissue is typically associated with left-sided inflammatory bowel disease or infection. Due to emerging cases of Chlamydia proctitis, we aim to investigate the prevalence of Chlamydia infection using immunohistochemistry (IHC) in anorectal biopsies showing ulcer and granulation tissue. Seventy-seven patients including 60 males and 17 females with mean age of 51 years old were retrospectively identified in surgical pathology archives. Chlamydia IHC was validated with a monoclonal antibody on an index who was positive for Chlamydia by rectal swab nucleic acid amplification test (NAAT), then performed on formalin fixed and paraffin embedded (FFPE) tissue sections. Confirmative molecular test using real-time PCR was performed on DNA extractions of 14 IHC-positive and 14 IHC-negative FFPEs, 18 NAAT-positive, and 5 NAAT-negative cytology specimens. Chlamydia IHC showed strong intracytoplasmic or extracellular sphere morphology in 14 of 77 (18.2 %) FFPEs, including 11 of 60 (18.3 %) males and 3 of 17 (17.6 %) females (age 11-84 years). Eight of 14 (57.1 %) Chlamydia-IHC positive patients had known history of STDs, high-risk behavior, or immunosuppressive conditions. One of 14 (7.1 %) IHC-positive FFEP and 15 of 18 (83.3 %) NAAT-positive cytology cases were confirmed by real-time PCR. Chlamydia inclusions were detected in all 4 randomly selected NAAT and PCR-positive cytology specimens by IHC. Our data suggested that Chlamydia infection is more prevalent than we thought in patients with active proctitis and ulceration. Chlamydia IHC may be performed as a screening test in biopsies to facilitate early detection of this treatable proctitis in high-risk population.
Topics: Male; Female; Humans; Middle Aged; Child; Adolescent; Young Adult; Adult; Aged; Aged, 80 and over; Immunohistochemistry; Ulcer; Retrospective Studies; Prevalence; Chlamydia Infections; Proctitis; Granulation Tissue
PubMed: 38159868
DOI: 10.1016/j.humpath.2023.12.009 -
Sexually Transmitted Infections Sep 2022Anorectal infections with (CT) are common in women visiting STI outpatient clinics. We here evaluated the risk posed by sexual exposure and by alternate anatomical site... (Observational Study)
Observational Study
BACKGROUND
Anorectal infections with (CT) are common in women visiting STI outpatient clinics. We here evaluated the risk posed by sexual exposure and by alternate anatomical site infection for incident anorectal and urogenital CT.
METHODS
Prospective multicentre cohort study, FemCure. Participants were treated for CT, and after 4, 6, 8, 10 and 12 weeks, they self-collected anorectal and urogenital samples (swabs) for CT-DNA testing. We calculated the proportion with incident CT, that is, CT incidence (at weeks 6-12) by 2-week time-periods. Compared with no exposure (A), we estimated the risk of incident CT for (B) sexual exposure, (C) alternate site anatomic site infection and (D) both, adjusted for confounders and expressed as adjusted ORs with 95% CIs.
RESULTS
We analysed data of 385 participants contributing 1540 2-week periods. The anorectal CT incidence was 2.9% (39/1343) (95 CI 1.8 to 3.6); 1.3% (A), 1.3% (B), 27.8% (C) and 36.7% (D). The ORs were: 0.91 (95% CI 0.32 to 2.60) (B), 26.0 (95% CI 7.16 to 94.34) (C), 44.26 (95% CI 14.38 to 136.21) (D).The urogenital CT incidence was 3.3% (47/1428) (95% CI 2.4 to 4.4); 0.7% (A), 1.9% (B), 13.9% (C) and 25.4% (D). The ORs were: 2.73 (95% CI 0.87 to 8.61) (B), 21.77 (95% CI 6.70 to 70 71) (C) and 49.66 (95% CI 15.37 to 160.41) (D).
CONCLUSIONS
After initial treatment, an alternate anatomical site CT infection increased the risk for an incident CT in women, especially when also sex was reported. This may suggest a key role for autoinoculation in the re-establishment or persistence of urogenital and anorectal chlamydia infections.
Topics: Chlamydia Infections; Chlamydia trachomatis; Cohort Studies; Female; Gonorrhea; Humans; Prospective Studies; Sexual Behavior
PubMed: 35039435
DOI: 10.1136/sextrans-2021-055032 -
Annals of the Royal College of Surgeons... Sep 2008Pruritus ani is a common condition with many causes, predominately anorectal pathology. There are some new insights and therapies, but the most recommendations are based... (Review)
Review
INTRODUCTION
Pruritus ani is a common condition with many causes, predominately anorectal pathology. There are some new insights and therapies, but the most recommendations are based on low-level evidence.
PATIENTS AND METHODS
A literature search was carried out using Medline and the internet with the keywords 'pruritus ani' from 1950 to 2007.
RESULTS
A review of the evidence is presented and a management plan based on the elimination of irritants and scratching, general control measures and active treatment measures is offered.
CONCLUSIONS
Treatment of primary and secondary pruritus ani has a good prospect of regression of symptoms and skin changes.
Topics: Anti-Infective Agents; Clothing; Dermatitis, Allergic Contact; Dermatologic Agents; Diet; Feces; Humans; Hygiene; Infections; Irritants; Lichen Sclerosus et Atrophicus; Medical History Taking; Physical Examination; Pruritus Ani; Psoriasis; Skin Neoplasms
PubMed: 18765023
DOI: 10.1308/003588408X317940 -
Revista de Gastroenterologia de Mexico 1996The incidence of VIH-related disease has arisen dramatically in the last decade. Many of these patients will present with specific anorectal complaints. (Comparative Study)
Comparative Study Review
BACKGROUND
The incidence of VIH-related disease has arisen dramatically in the last decade. Many of these patients will present with specific anorectal complaints.
PURPOSE
This review paper was performed to discuss the diagnostic and therapeutic implications of anorectal diseases in patients with VIH infection.
RESULTS
A detailed sexual history is important in order to document the mode of transmission. The nature of the anorectal complaint is then evaluated and classified as infectious, neoplastic or idiopathic. Treatment should be planned accordingly.
CONCLUSIONS
In the 1990's it's important that the physician who cares for patients with anorectal complaints be familiar with VIH-related diseases and their treatment plans.
Topics: AIDS-Related Opportunistic Infections; Anus Diseases; Anus Neoplasms; Carcinoma, Squamous Cell; Condylomata Acuminata; Cytomegalovirus Infections; Diagnosis, Differential; Female; Fissure in Ano; HIV Infections; Herpes Simplex; Humans; Lymphoma; Male; Mycobacterium Infections, Nontuberculous; Rectal Diseases; Sarcoma, Kaposi
PubMed: 8927918
DOI: No ID Found -
Annals of Internal Medicine Oct 2022
Topics: HIV Infections; Homosexuality, Male; Humans; Male; Monkeypox virus; Paris; Prevalence; Sexual and Gender Minorities; Sexually Transmitted Diseases
PubMed: 35969863
DOI: 10.7326/M22-2183 -
The Lancet. Microbe Apr 2024Control of Neisseria gonorrhoeae infection (gonorrhoea) depends on effective testing strategies. Anorectal testing in women is often done on indication of anal sex;...
Anorectal Neisseria gonorrhoeae infections in women with and without reported anal sex and sex workers in sexual health centres in the Netherlands: a retrospective cohort study.
BACKGROUND
Control of Neisseria gonorrhoeae infection (gonorrhoea) depends on effective testing strategies. Anorectal testing in women is often done on indication of anal sex; however, anorectal infections are seen with and without anal exposure, possibly caused by autoinoculation. This study aims to enhance understanding of anorectal infections in women, by identifying risk factors for anorectal diagnosis.
METHODS
In this retrospective cohort study we used national surveillance data from Dutch sexual health centres from Jan 1, 2016, to Dec 31, 2021. We included cisgender women having sex with men who were tested urogenitally and anorectally for gonorrhoea. Due to different testing policies, we identified three groups: women who had not reported recent anal sex (in the past 6 months), women who had reported recent anal sex, and sex workers. Extracted data for analyses included demographics, sexual behaviour, and diagnosis of a sexually transmitted infection (STI). Per group, multivariable models using Firth's penalised maximum likelihood logistic regression were constructed, identifying determinants of anorectal gonorrhoea among all women and among gonorrhoea-positive women only. Variables included in model construction were age, education level, migration background, number of partners, condom use, partner notification, STI symptoms, having a partner who has sex with men (MSM) or a migrant partner, previous STI test, anal sex, and chlamydia and gonorrhoea diagnoses per anatomical location.
FINDINGS
In total, 117 693 women were included: 43 757 women without reported recent anal sex, 51 728 women with reported recent anal sex, and 22 208 sex workers. In all three groups, around 2% of women were gonorrhoea positive, and 70% or more of women had an anorectal infection. The strongest determinant of anorectal gonorrhoea was a concurrent urogenital gonorrhoea diagnosis (adjusted odds ratios [aOR] 782 [95% CI 605-1018]) among women without reported recent anal sex (612 [490-768] among women with reported recent anal sex, and 464 [335-652] among sex workers). Among gonorrhoea-positive women, determinants of anorectal gonorrhoea were urogenital and anorectal chlamydia co-infection (aOR 2·03 [95% CI 1·38-3·02], for women without reported anal sex) and migration background (1·44 [1·02-2·06], for women with reported anal sex). Determinants among sex workers were condomless sex (2·43 [1·55-3·82]), anal sex (1·71 [1·10-2·66]), MSM or migrant partner (1·78 [1·13-2·79]), and urogenital and anorectal chlamydia co-infection (2·28 [1·11-5·14]).
INTERPRETATION
These findings support the possibility of an autoinoculation process from the urogenital to the anorectal location due to the very strong correlation between urogenital and anorectal gonorrhoea, and due to the similarity of results across all three groups. Current testing strategies could miss anorectal infections, which should be considered when developing gonorrhoea prevention and control guidelines.
FUNDING
None.
Topics: Male; Humans; Female; Gonorrhea; Neisseria gonorrhoeae; Sex Workers; Homosexuality, Male; Sexual Health; Coinfection; Netherlands; Retrospective Studies; Chlamydia trachomatis; Sexual and Gender Minorities; Sexual Behavior; Sexually Transmitted Diseases; Chlamydia Infections
PubMed: 38359858
DOI: 10.1016/S2666-5247(23)00376-2 -
Der Hautarzt; Zeitschrift Fur... Apr 2020Sexually transmitted infections (STIs) in the anorectal region are disproportionally detected in risk populations such as men who have sex with men (MSM). However, due... (Review)
Review
BACKGROUND
Sexually transmitted infections (STIs) in the anorectal region are disproportionally detected in risk populations such as men who have sex with men (MSM). However, due to changes in sexual behaviour they are increasingly diagnosed in heterosexual individuals. Due to the recent implementation of oral HIV pre-exposure prophylaxis together with lack of condom use, a further rise in STIs is expected.
OBJECTIVES
This review addresses epidemiology, clinical picture, diagnostic pitfalls and current therapy guidelines of "classical" bacterial STIs involving the anorectum.
CONCLUSIONS
STI manifestations in the anal region are frequently nonspecific or asymptomatic so that the diagnosis may be missed. In an endoscopic examination of the rectum, they can even mimic inflammatory bowel disease or malignancy. Therefore, knowledge of possible symptoms of bacterial STIs in this area is helpful for early diagnosis. Coinfections with other STIs are common and should prompt a search of other pathogens including HIV and hepatitis B/C.
Topics: Anus Diseases; Chlamydia Infections; Coinfection; Female; Gonorrhea; HIV Infections; Heterosexuality; Homosexuality, Male; Humans; Lymphogranuloma Venereum; Male; Rectal Diseases; Sexual Behavior; Sexually Transmitted Diseases; Syphilis; Unsafe Sex
PubMed: 32025745
DOI: 10.1007/s00105-020-04547-w -
Diseases of the Colon and Rectum Nov 1998Anorectal diseases are common in human immunodeficiency virus-infected individuals. The aim of this prospective study was to assess the cause and clinical presentation...
PURPOSE
Anorectal diseases are common in human immunodeficiency virus-infected individuals. The aim of this prospective study was to assess the cause and clinical presentation of anorectal disease in this human immunodeficiency virus-infected population.
METHODS
A registry of all human immunodeficiency virus-seropositive patients with anorectal complaints who were referred to and followed up in the colorectal surgery clinic at a county hospital was maintained, with all data collected prospectively. All patients underwent examination under anesthesia with random cultures and biopsies, along with specific sampling of any suspicious lesions.
RESULTS
Data from 180 consecutive human immunodeficiency virus-seropositive patients with anorectal symptoms were analyzed. Mean age of the population was 34 years, with a male-to-female ratio of 14:1. This group comprised homosexual and bisexual males (55 percent), injection-drug users (15 percent), heterosexuals (12 percent), and others (18 percent). The average lag time from diagnosis of human immunodeficiency virus to anorectal symptoms was 48 months. The average CD4 lymphocyte count was 160 cells/mm3. The most common symptom was anorectal pain (57 percent), followed by lumps or warts (28 percent), rectal bleeding (12 percent), discharge (11 percent), and pruritus (6 percent), with 24 percent of patients having multiple complaints. Anal condyloma was the most prevalent pathology observed (43 percent), of which 10 percent was associated with anal intraepithelial neoplasia. Wide-based anal ulcers were the most frequent noncondylomatous lesions, occurring in 32 percent of patients, with the majority (91 percent) presenting with the chief complaint of anorectal pain. Some of these ulcers were associated with viral infections: herpes simplex virus (12 percent) and cytomegalovirus (7 percent). However, most ulcers were idiopathic, with negative cultures and biopsies. Other lesions encountered included fistulas (14 percent), abscesses (12 percent), hemorrhoids (6 percent), and malignancy, with two cases of Kaposi's sarcoma, one case of non-Hodgkin's lymphoma, and one case of squamous-cell carcinoma. More than one anorectal condition was identified in 16 percent of the patients.
CONCLUSIONS
Human immunodeficiency virus infection is associated with a wide spectrum of anorectal disease, of which the most common lesions are anal condylomata and painful ulcers. The majority of these anal ulcers gave negative culture and biopsy results. In addition, there seems to be a high incidence of anorectal neoplasia in this patient population.
Topics: Adolescent; Adult; Aged; Condylomata Acuminata; Female; HIV Infections; Humans; Male; Middle Aged; Prospective Studies; Rectal Diseases
PubMed: 9823801
DOI: 10.1007/BF02237051 -
Problemy Sotsial'noi Gigieny,... May 2021The gonorrhea is a sexually transmitted infection caused by Neisseria gonorrhoeae. N. gonorrhoeae being tropic to columnar epithelium, primarily infects mucosa of... (Review)
Review
The gonorrhea is a sexually transmitted infection caused by Neisseria gonorrhoeae. N. gonorrhoeae being tropic to columnar epithelium, primarily infects mucosa of urogenital system, rectum, pharynx and conjunctiva. According the WHO, in 2016 about 87 million of new cases of gonorrhea were registered in the age group of 15-49 years old. The number of new gonorrhea cases increases steadily in many countries. The significant contribution into propagation of infection is made by males practicing sex with males, migrants, commercial sex workers, ethnic minorities. The undetected cervical gonococcus infection can result in such severe complications as inflammatory diseases of organs of small pelvis and infertility that directly impacts the reproductive losses of population. The anorectal and and pharyngeal gonorrhea very often takes asymptomatic course that complicates diagnostic and effects the statistical picture of morbidity. The apprehension of world trends in epidemiology of gonococcal infection can become a key point in implementation and development of national and international programs of prevention of propagation of this disease. The review of national and world publications concerning actual clinical epidemiological characteristics of gonococcus infection was implemented through such on-line search systems as PubMed, Google Scholar, BioMed Central (95 publications in total). The conclusions are made about steady increasing of morbidity due to propagation of infection in groups of risky sexual behavior, application of modern diagnostic means and patterns of clinical course of gonorrhea. The role of sexually transmitted infections in development of infertility, inflammatory diseases of organs of small pelvis, miscarriage and reproductive losses of poplation is marked.
Topics: Adolescent; Adult; Gonorrhea; Humans; Male; Middle Aged; Neisseria gonorrhoeae; Sexual Behavior; Sexually Transmitted Diseases; Young Adult
PubMed: 34190475
DOI: 10.32687/0869-866X-2021-29-3-451-455