Hepatobiliary and Pancreatic: Multiple sexually transmitted infections

Abstract

Sexually transmitted infections continue to be a significant medical problem in men who have sex with men. Some of these patients will be seen in gastroenterology and hepatology clinics while others will attend clinics for sexually transmitted disorders. Although the recognition of acquired immunodeficiency syndrome (AIDS) was followed by the use of safer sex practices in the 1980s, epidemiologic studies now indicate increasing rates for at least some infections such as anorectal gonorrhea and syphilis. The common anorectal infections in homosexual men are herpes simplex virus, Neisseria gonorrhoeae, syphilis and Chlamydia trachomatis. Common symptoms include anal pain, an anal discharge, pruritis and pain with defecation. In patients who have diarrhea (without AIDS), common causative organisms are the protozoa, Giardia lamblia and Entamoeba histolytica, as well as bacterial pathogens such as Campylobacter and Clostridium difficile. Homosexual men also have a higher than expected frequency of hepatitis B and, to a lesser extent, hepatitis C. Again, risks for these infections increase in those with multiple sexual partners and with anal-receptive intercourse.The susceptibility of these patients to multiple gastrointestinal and other infections is illustrated by the following report. The patient was a 55-year-old man who was admitted to hospital with jaundice, an unusual rash and rectal bleeding. Apart from jaundice, he had small round papules on his palms and soles