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DOP022. Sexual behaviours in patients attending an IBD clinic - should we ask about it?

A. Morieux1, C. Mowat2, N. Reynolds2, J. Todd2, A. Meritsi2, S. Allstaff3, M. Groome2, 1University of Dundee Medical School, Medical School, Dundee, United Kingdom, 2Ninewells Hospital & Medical School, Gastroenterology, Dundee, United Kingdom, 3Ninewells Hospital & Medical School, Sexual & Reproductive Health, Dundee, United Kingdom

Background

In the UK and many other western countries there has been a sustained annual increase in the incidence of sexually transmitted infections (STIs) over the past decade [1]. Gonorrhea, chlamydia, syphilis and herpes infection can present with rectal symptoms and endoscopic features that can mimic inflammatory bowel disease (IBD). Traditionally patients who disclose having anal sexual intercourse and present with rectal symptoms are referred to the genitourinary service where a sexual history is taken and STI proctitis considered. Patients who do not disclose anal sex to the primary referrer are usually sent to a gastroenterology clinic where sexually transmitted causes are usually not considered and a sexual history is not routinely taken. The aim of this project was to assess the prevalence of anal sex in a population referred to an IBD clinic with rectal symptoms; and to determine if there were associations between sexual practice and rectal symptoms reported.

Methods

Prospectively a sexual health questionnaire was distributed to patients attending the IBD Clinics in a tertiary Teaching Hospital setting over a 6 week period. The questionnaire recorded age, sexual orientation, number of sexual partners, sexual sites, STI and rectal symptoms. Results were compared to the Scottish figures from The National Survey of Sexual Attitudes and Lifestyles 2 (NATSAL2) [2].

Results

Only 2 men disclosed having sex with men so analysis was limited to female patients. 170 females completed a questionnaire (age range 16–81). The incidence of receptive anal sex with men within the age group 17–44 (the age range in NATSAL2) was 23.5% compared with 13.4% in NATSAL2. Regarding chronic symptoms: Rectal pain was reported in 41.6% of those having anal sex versus 15% in those not (p < 0.002), rectal bleeding was reported in 29.2% of those having anal sex versus 28% in those not (p = NS) and rectal discharge was reported in 25% of those having anal sex versus 11.6% in those not (p = 0.076). These symptoms were reported on a chronic basis and were not related to discrete episodes of anal sex. Past STI infection rates were shown as 29.2% in those having anal sex versus 4.8% in those not (p < 0.0001).

Conclusion

The prevalence of anal sex is higher in this cohort than the general population. A lack of routine sexual health questioning in an IBD clinic will fail to identify those at risk of rectal STIs. Chronic rectal pain was strongly associated with a history of anal sex and should trigger a thorough sexual history. When receptive anal sex is disclosed STI screening should be offered to this cohort to exclude a STI pathogen. Further studies are planned in this high risk group.

1. Health Protection Agency, (2012), New data show sexually transmitted infection diagnoses on the rise in England, http://www.hpa.org.uk/NewsCentre/, 2012–01–01

2. Anne M Johnson, Catherine H Mercer, Bob Erens, Andrew J Copas, Sally McManus, Kaye Wellings, Kevin A Fenton, (2001), Sexual behaviour in Britain: partnerships, practices, and HIV, The Lancet, 2013–01–01