1. GUM AND THE ANUS Ben Goorney Salford 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.

8. 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

13. Tropical Bubos(G.Ing/Chancroid)

18. Early(secondary) Syphilis

19. 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.

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

21. Cryptosporidiosis

22. CMV Disease

23. Kaposis Sarcoma

24. 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.

25. “Canal Street”- Manchester