Anorectal disease

Perianal discomfort is often caused by recurrent herpes simplex infection. The diagnosis should be confirmed by viral culture. Patient-initiated intermittent aciclovir can give adequate symptom control in some cases but many patients will require long-term maintenance therapy. Resistance to both aciclovir and ganciclovir has been reported. Foscarnet is then the treatment of choice.

Anal warts are common but rarely cause much in the way of symptoms and should be treated on merit given the absence of any effective antiviral therapy. Anal intraepithelial neoplasia has been described in association with human papillomavirus infection but reports of invasive malignancy are still infrequent.

Patients may present with a mucopurulent proctitis, possible causes of which include recently acquired or long-standing Neisseria gonorrhoeae or Chlamydia trachomatis infection.

Figure 7.5 ERCP of AIDS sclerosing cholangitis with intrahepatic biliary tract distortion and dilatation of the common bile duct
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