Sian L Goddard1, I Mary Poynten2, Kathy Petoumenos3, Fengyi Jin2, Richard J Hillman4, Carmella Law4, Jennifer M Roberts5, Christopher K Fairley6, Suzanne M Garland7, Andrew E Grulich2, David J Templeton8. 1. HIV Epidemiology and Prevention Program, The Kirby Institute, UNSW Sydney, Level 6,Wallace Wurth Building, High Street, Sydney, NSW 2052, Australia; and Infection and Immunity, Ambrose King Centre, Barts Health NHS Trust, London, E1 2BB, UK; and Corresponding author. Email: sgoddard@kirby.unsw.edu.au. 2. HIV Epidemiology and Prevention Program, The Kirby Institute, UNSW Sydney, Level 6,Wallace Wurth Building, High Street, Sydney, NSW 2052, Australia. 3. Biostatistics and Databases Program, The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia. 4. Dysplasia and Anal Cancer Services, HIV Immunology and Infectious Disease Department, St Vincent's Hospital, Sydney, NSW 2010, Australia. 5. Cytology Department, Douglass Hanly Moir Pathology, Sydney, NSW 2113, Australia. 6. Central Clinical School, Monash University, Melbourne, Vic. 3044, Australia; and Melbourne Sexual Health Centre, Melbourne, Vic. 3053, Australia. 7. Centre for Women's infectious Diseases, Royal Women's Hospital, Melbourne, Vic. 3052, Australia; and Infection Immunity, Murdoch Children's Research Institute, Parkville, Vic. 3052, Australia; and Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Vic. 3052, Australia. 8. HIV Epidemiology and Prevention Program, The Kirby Institute, UNSW Sydney, Level 6,Wallace Wurth Building, High Street, Sydney, NSW 2052, Australia; and Department of Sexual Health Medicine and Sexual Assault Medicine, Sydney Local Health District, Camperdown, NSW 2050, Australia; and Sydney Medical School, The University of Sydney, NSW 2006, Australia.
Abstract
Background Anal symptoms may indicate serious pathology. Receptive anal intercourse (RAI) and sexually transmissible infections (STIs) may contribute to a higher prevalence of symptoms among gay and bisexual men (GBM). This study investigated associations with anal symptoms among GBM. METHODS: The Study of the Prevention of Anal Cancer was a longitudinal study of anal human papillomavirus and related lesions in Sydney, Australia. GBM aged ≥35 years were recruited from community settings between September 2010 and August 2015. Information about anal symptoms (discharge, itch, pain defecating, lump, bleeding, 'sores', tearing, tenesmus), STIs and sexual behaviours was collected. High-resolution anoscopy (HRA) and STI testing were performed. Logistic regression analyses on baseline data were performed to assess associations with each symptom. RESULTS: Among 616 participants (median age 49 years, 35.9% HIV positive), 35.3% reported at least one anal symptom within the past week and 65.3% were diagnosed with fistula, fissure, ulcer, warts, haemorrhoids and/or perianal dermatoses at HRA. Anal symptoms were not associated with anal chlamydia, gonorrhoea, warts or syphilis. Self-reported 'sores' were associated with previous anal herpes simplex virus (HSV; P < 0.001). 'Sores' (P < 0.001), itch (P = 0.019), discharge (P = 0.032) and lump (P = 0.028) were independently associated with ulceration. Among participants diagnosed with fissure, fistulae, haemorrhoids and perianal dermatoses, 61.9%, 100%, 62.0% and 63.9% respectively were asymptomatic. Only self-reported anal tear was independently associated with recent RAI. CONCLUSIONS: Previous anal HSV was the only STI associated with any symptom. Anal pathology was highly prevalent, but often asymptomatic. Anal symptoms do not appear to be useful markers of most anal pathology in GBM.
Background Anal symptoms may indicate serious pathology. Receptive anal intercourse (RAI) and sexually transmissible infections (STIs) may contribute to a higher prevalence of symptoms among gay and bisexual men (GBM). This study investigated associations with anal symptoms among GBM. METHODS: The Study of the Prevention of Anal Cancer was a longitudinal study of anal human papillomavirus and related lesions in Sydney, Australia. GBM aged ≥35 years were recruited from community settings between September 2010 and August 2015. Information about anal symptoms (discharge, itch, pain defecating, lump, bleeding, 'sores', tearing, tenesmus), STIs and sexual behaviours was collected. High-resolution anoscopy (HRA) and STI testing were performed. Logistic regression analyses on baseline data were performed to assess associations with each symptom. RESULTS: Among 616 participants (median age 49 years, 35.9% HIV positive), 35.3% reported at least one anal symptom within the past week and 65.3% were diagnosed with fistula, fissure, ulcer, warts, haemorrhoids and/or perianal dermatoses at HRA. Anal symptoms were not associated with anal chlamydia, gonorrhoea, warts or syphilis. Self-reported 'sores' were associated with previous anal herpes simplex virus (HSV; P < 0.001). 'Sores' (P < 0.001), itch (P = 0.019), discharge (P = 0.032) and lump (P = 0.028) were independently associated with ulceration. Among participants diagnosed with fissure, fistulae, haemorrhoids and perianal dermatoses, 61.9%, 100%, 62.0% and 63.9% respectively were asymptomatic. Only self-reported anal tear was independently associated with recent RAI. CONCLUSIONS: Previous anal HSV was the only STI associated with any symptom. Anal pathology was highly prevalent, but often asymptomatic. Anal symptoms do not appear to be useful markers of most anal pathology in GBM.
Authors: Bryan A Kutner; Jane M Simoni; Will DeWitt; Michael M Gaisa; Theodorus G M Sandfort Journal: LGBT Health Date: 2022-02-07 Impact factor: 5.150