ANAL WARTS, SEXUALLY TRANSMITTED DISEASES, AND ANORECTAL CONDITIONS ASSOCIATED WITH HUMAN IMMUNODEFICIENCY VIRUS

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Anorectal sexually transmitted diseases (STDs) are reaching epidemic proportions in the United States. These STDs have varying presentations and sequelae and can mimic noninfectious anorectal disorders. If providers are not aware of and do not have appropriate suspicion for these diseases, they often go undiagnosed and untreated. This article specifically addresses the common presentations and management options for anal warts and other STDs, including gonorrhea, chlamydia, syphilis, herpes, and anorectal manifestations associated with the human immunodeficiency virus (HIV).

Section snippets

ANAL WARTS

Anal warts are caused by an infection with the human papilloma virus. The annual incidence of anal and genital warts continues to increase. Over the past decade, medical knowledge concerning anal warts, including its link with dysplasia and squamous cell carcinoma, has grown tremendously. New treatment options continue to be developed; however, anal warts remain difficult to completely eradicate, frustrating both patients and providers.

ANORECTAL SEXUALLY TRANSMITTED DISEASES

Anal receptive intercourse (ARI) is an increasingly common behavior. It is estimated that 4% to 13% of adult men in the United States are homosexual or bisexual, and 10% of heterosexual women engage in ARI. With the increased practice of ARI, the number of cases and types of anorectal STDs continue to grow. ARI has a known, increased risk of disease transmission when compared with vaginal intercourse; however, the greatest transmission risk is sexual engagement with multiple partners.

ANAL MANIFESTATIONS OF HIV AND AIDS

The Centers for Disease Control (CDC) estimates that over 1 million Americans are infected with HIV. Although there is great promise in new therapies for AIDS and in preventive vaccines, the disease continues to devastate the homosexual and intravenous drug-user communities. Transmission patterns are changing, with heterosexually acquired infection on the rise, making HIV a concern for everyone.

Anorectal disorders associated with HIV and AIDS are common and can be very debilitating. In one

CONCLUSION

Anorectal STDs are an increasingly common problem. The practice of ARI is the most significant factor in disease transmission. These STDs have varying presentations and sequelae, ranging from painless lesions to severe proctitis. They can often be confused with noninfectious anorectal disorders. Of particular concern are the numerous infections that remain asymptomatic, yet are still potentially infectious.

When a patient presents with an anorectal complaint, STDs must always be considered in

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