Goddard Sian L, Poynten I Mary, Petoumenos Kathy, Jin Fengyi, Hillman Richard J, Law Carmella, Roberts Jennifer M, Fairley Christopher K, Garland Suzanne M, Grulich Andrew E, Templeton David J
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:
HIV Epidemiology and Prevention Program, The Kirby Institute, UNSW Sydney, Level 6,Wallace Wurth Building, High Street, Sydney, NSW 2052, Australia.
Sex Health. 2021 May;18(2):123-129. doi: 10.1071/SH20104.
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.
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.
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.
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.
背景 肛门症状可能提示严重病变。接受性肛交（RAI）和性传播感染（STIs）可能导致男同性恋者和双性恋男性（GBM）中症状的患病率更高。本研究调查了GBM中肛门症状的相关因素。
肛门癌预防研究是一项在澳大利亚悉尼进行的关于肛门人乳头瘤病毒及相关病变的纵向研究。2010年9月至2015年8月期间，从社区招募年龄≥35岁的GBM。收集了有关肛门症状（分泌物、瘙痒、排便疼痛、肿块、出血、“溃疡”、撕裂伤、里急后重）、性传播感染和性行为的信息。进行了高分辨率肛门镜检查（HRA）和性传播感染检测。对基线数据进行逻辑回归分析，以评估与每种症状的相关性。
在616名参与者（中位年龄49岁，35.9%为HIV阳性）中，35.3%报告在过去一周内至少有一项肛门症状，65.3%在HRA检查中被诊断为肛瘘、肛裂、溃疡、疣、痔疮和/或肛周皮肤病。肛门症状与肛门衣原体、淋病、疣或梅毒无关。自我报告的“溃疡”与既往肛门单纯疱疹病毒（HSV；P < 0.001）有关。“溃疡”（P < 0.001）、瘙痒（P = 0.019）、分泌物（P = 0.032）和肿块（P = 0.028）与溃疡独立相关。在被诊断为肛裂、肛瘘、痔疮和肛周皮肤病的参与者中，分别有61.9%、100%、62.0%和63.9%无症状。只有自我报告的肛门撕裂伤与近期接受性肛交独立相关。
既往肛门HSV是唯一与任何症状相关的性传播感染。肛门病变非常普遍，但通常无症状。肛门症状似乎不是GBM中大多数肛门病变的有用标志物。
