Anorectal diseases seen in AIDS patients include both infections and tumors. HSV is the most common infectious agent found. Vesicles in the anal canal may be missed as they rupture during defecation or examination. Herpes infection in AIDS patients most often presents as a painful, shallow spreading perineal ulcer. A smaller group of patients present with idiopathic ulcers, originating at the anorectal junction. Perianal and intra-anal condylomata occur in AIDS patients as well as non-AIDS patients and are related to infection with HPV. Tumors in the anorectal region include KS, lymphoma, and squamous cell carcinoma or its variants.
Hemorrhoidal disease also is seen frequently. Factors predisposing to hemorrhoids may have predated the HIV infection. Severe diarrhea or proctitis may promote local thrombosis, ulceration, and secondary infection. Fleshy skin tags, resembling those seen in Crohn's disease, are also seen. Thrombosed hemorrhoids occur frequently, but it is unclear if the incidence is higher in AIDS patients than in a comparable population.
A variety of classic venereal diseases can produce anorectal ulcerations. Diagnosis and treatment of Neisseria gonorrhoea proctitis is similar in AIDS and non-AIDS patients. Syphilis may have an atypical presentation in HIV-infected subjects, and serologic diagnosis is affected by the presence of immune deficiency. Chlamydia is prevalent in sexually active groups. The frequency of chancroid, caused by Haemophilus ducreyi, in HIV-infected patients is unknown. Rectal spirochetosis has been recognized in homosexual men with or without HIV infection (Nielsen et al, 1983). The infection usually is asymptomatic and an incidental finding on examination.
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