Trauma and other noninfectious problems in homosexual men

Persistent Ulceration of the Anal Margin in Homosexuals with Hiv Infection

A study of the outcome of surgical treatment of ulceration of the anal margin occurring in male homosexuals with HIV infection was undertaken. Ten patients with acquired immunodeficiency syndrome and three patients with symptomatic HIV infection were referred to the Department of Surgery with painful anal ulceration which had not responded to medical treatment. The medical treatments given prior to surgical referral included high dose oral acyclovir, intravenous foscarnet and broad spectrum antibiotics. Excision biopsy was performed in 12 patients and in 11 cases was followed by healing of the ulcers within 10 weeks. One patient died 2 weeks postoperatively from Pneumocystis carinii pneumonia without healing. The response to excision biopsy was unexpected but suggests that surgical excision may be beneficial for lesions which have failed to respond to aggressive medical treatment.

Retained foreign body in a 14-year-old boy

The authors describe a 14-year-old boy who presented at the emergency department after he deliberately inserted a soda can in his rectum 48 hours before presentation. The authors were able to remove the foreign body in the operating room by squeezing and twisting the upper round of the empty soda can, in this way changing the original cylinder shape into a conus-shape. Retained foreign bodies in the rectum of children are rare. The authors report our case and discuss the relevant literature.

Surgery for anal lesions in HIV-infected patients

Anorectal manifestations are commonplace in patients with HIV infection. However, standardized or rational treatment of these conditions has not been proposed and many patients are denied adequate treatment based on fear of complications. This review looks critically at the available literature to draw conclusions about treatment, results and complications of surgery for anorectal problems in these patients.

Effect of Anoreceptive Intercourse on Anorectal Function

This study is the first published assessment of the effect of anoreceptive intercourse (ARI) on anal sphincter tone and function. Forty anoreceptive (AR) male homosexuals were compared with 18 age matched non-anoreceptive (non-AR) heterosexual males. Subjects were questioned about ARI, defaecation and faecal incontinence. Anal resting pressure, maximum voluntary squeeze pressure, anal mucosal electrosensitivity, perineal descent and rectal sensation were measured in all subjects. Fourteen of the AR subjects but only one of the non-AR subjects had symptoms of frequent anal incontinence ( P<0.05). There was a significant reduction in both maximum anal resting pressure ( P<0.01) and anal mucosal electrosensitivity ( P<0.05) and a significant difference in the anal resting pressure profile ( P=0.02) in the AR subjects compared with the non-AR subjects. There was a significant reduction in maximum squeeze pressure in AR subjects with anal incontinence compared with either AR subjects without anal incontinence ( P<0.01) or non-AR subjects ( P<0.01). There were no significant differences in stool consistency, frequency of defaecation, perineal descent or rectal sensation between the groups. ARI is associated with reduced resting pressure in the anal canal and an increased risk of anal incontinence. The risk of incontinence is greatest amongst AR subjects with reduced maximum squeeze pressure.

Surgical management of anorectal disease in HIV-positive homosexuals

One thousand and ninety human immunodeficiency virus (HIV)-positive homosexual or bisexual males were seen in one hospital for management of HIV disease over a 9-year period. One hundred and fifty-five patients were referred by acquired immunodeficiency syndrome (AIDS) physicians for general surgical management. The most frequent reason for surgical referral (64 patients) was anorectal disease which occurred in 5.9 per cent of all HIV-positive patients. One or more diagnoses were reached in 61 of the 64 patients referred with anorectal disease: warts (38 per cent of diagnoses), anorectal ulceration (26 per cent), perianal sepsis (15 per cent), neoplasia (14 per cent) and haemorrhoidal disease (8 per cent). Anorectal symptoms were relieved in 68 per cent of patients and the median survival of those treated was 17.5 months from the time of surgical referral. Both warts and perianal sepsis were associated with in situ neoplasia, but no case of progression from in situ to invasive anal squamous carcinoma was detected. The aetiology of anorectal ulcers was not clear, but surgical excision of anal ulcers and skin tags can produce healing. Palliation of anorectal symptoms in HIV-positive homosexual patients is possible but some conditions are unusual and surgeons should be familiar with their presentation and management.

Male homosexuality, HIV infection and colorectal surgery

The sexual practices of male homosexuals may lead to the development of a wide variety of colorectal and perianal diseases. This review describes the pathogenesis of these conditions, their management, and the influence of HIV infection on these conditions.

Sexually transmitted diseases in homosexual adolescents

In 1986, an estimated 13 million cases of sexually transmitted diseases (STDs) were diagnosed in the United States, with the highest incidence rates occurring within the adolescent age group. Homosexual adolescent men are at particularly high risk for STDs. Because of the myriad clinical presentations of STD in gay men, these diseases are often not recognized as being sexually transmitted. In this paper, the epidemiology and clinical features of STDs in gay adolescents are discussed. The sexual history is emphasized as an integral tool in developing a differential diagnosis. A priori, the sexual history also can give a risk-assessment profile for STD. Clinical aspects of STD are reviewed using a syndrome approach, and the diagnostic workup is outlined for the etiologic agents most likely implicated in each syndrome. Clinical signs and symptoms of urethritis, genital ulcers and papular lesions, pharyngitis, and hepatitis are reviewed. Sexually acquired gastrointestinal disorders are described. As the AIDS epidemic continues, disease prevention, risk reduction, and patient education are becoming more important. Current recommendations for "safer sex" practices are reviewed.