Background Surgical conditions often coexist with sexually transmitted infections (STI) and viceversa among people who engage in anal sex. However, when treating this category of patients, surgeons often do not pay any attention to the role of anal STIs and infectivologists disregard surgical issues. The aim of our study was to assess the burden of anorectal conditions in a population of subjects examined at a large urban STI Clinic in Turin, Italy. Methods On July 1, 2005, a pilot project was initiated by opening a special outpatient clinic at one of the major STIs centres of Turin, a large industrial city in Northwest Italy. Examinations were carried out by the same surgeon with the collaboration of an infectivologist. Asymptomatic patients who practiced anal sex or patients with symptoms related to suspected STI or any other anal condition or HIV-positive patients with anogenital disorders were referred to the clinic for anoscopy and microbiological testing. Biopsy was performed if the clinical picture indicated it was necessary. Results In the study period, more than 600 patients were examined. Eighty percent were male with a mean age of 36 years. Fifty-seven percent were men who have sex with men and 46% were HIV positive. Twelve percent did not report any subjective symptoms. The mean time interval from the onset of symptoms was 3 months, but 15% of patients reported symptoms lasting for more than 12 months. The most frequent pathologies were anogenital warts (39%), hemorrhoids (17%), and anal fissures, ulcers and fistulas (6%). Sixteen percent were affected by other STI (Syphilis, Chlamydia trachomatis and herpes simplex virus infection). It is important to note that 10 cases of lymphogranuloma venereum were diagnosed. These were all cases of were missed diagnoses in other clinical settings. Eighteen cases of neoplasms were diagnosed. Fifty percent were malignant and all were observed in HIV-positive patients (80% males, 62% homosexuals). None of the patients were aware of the cancer risk and the majority of patients with a Buschke Lowenstein tumour do not feel the lesion was ‘‘problematic’’. All HIV-positive patients except one were on HAART treatment. The majority of patients were having the proctology service in the same clinic setting as the STI clinic. Conclusions Regular check-up of the anus is essential among sexually active people because of the heavy burden of STI among people with anal conditions and viceversa. This is particularly important among HIV-positive people, irrespective of their immune status. A dedicated multidisciplinary proctology service should be implemented on a regular basis in every large urban STI clinic.
Usefulness of a multidisciplinary outpatient clinic in the management of infectious and degenerative anorectal diseases
CASSONI, Paola;MORINO, Mario;DI PERRI, Giovanni
2011-01-01
Abstract
Background Surgical conditions often coexist with sexually transmitted infections (STI) and viceversa among people who engage in anal sex. However, when treating this category of patients, surgeons often do not pay any attention to the role of anal STIs and infectivologists disregard surgical issues. The aim of our study was to assess the burden of anorectal conditions in a population of subjects examined at a large urban STI Clinic in Turin, Italy. Methods On July 1, 2005, a pilot project was initiated by opening a special outpatient clinic at one of the major STIs centres of Turin, a large industrial city in Northwest Italy. Examinations were carried out by the same surgeon with the collaboration of an infectivologist. Asymptomatic patients who practiced anal sex or patients with symptoms related to suspected STI or any other anal condition or HIV-positive patients with anogenital disorders were referred to the clinic for anoscopy and microbiological testing. Biopsy was performed if the clinical picture indicated it was necessary. Results In the study period, more than 600 patients were examined. Eighty percent were male with a mean age of 36 years. Fifty-seven percent were men who have sex with men and 46% were HIV positive. Twelve percent did not report any subjective symptoms. The mean time interval from the onset of symptoms was 3 months, but 15% of patients reported symptoms lasting for more than 12 months. The most frequent pathologies were anogenital warts (39%), hemorrhoids (17%), and anal fissures, ulcers and fistulas (6%). Sixteen percent were affected by other STI (Syphilis, Chlamydia trachomatis and herpes simplex virus infection). It is important to note that 10 cases of lymphogranuloma venereum were diagnosed. These were all cases of were missed diagnoses in other clinical settings. Eighteen cases of neoplasms were diagnosed. Fifty percent were malignant and all were observed in HIV-positive patients (80% males, 62% homosexuals). None of the patients were aware of the cancer risk and the majority of patients with a Buschke Lowenstein tumour do not feel the lesion was ‘‘problematic’’. All HIV-positive patients except one were on HAART treatment. The majority of patients were having the proctology service in the same clinic setting as the STI clinic. Conclusions Regular check-up of the anus is essential among sexually active people because of the heavy burden of STI among people with anal conditions and viceversa. This is particularly important among HIV-positive people, irrespective of their immune status. A dedicated multidisciplinary proctology service should be implemented on a regular basis in every large urban STI clinic.
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