Are patients in the IBD clinic at risk of proctitis secondary to sexually transmitted infections?

Objective

To gauge the potential risk of sexually transmitted infection (STI) as a cause of proctitis in a cohort of patients with inflammatory bowel disease (IBD) and to gauge whether this cohort could benefit from STI testing in the future.

Design

Patients attending the IBD clinic were given an anonymous questionnaire recording demographics, sexual behaviour, rectal symptoms, history of receptive anal intercourse (RAI), STIs and attitudes towards sexual health screening.

Setting

A gastroenterology teaching hospital IBD clinic.

Patients

280 consecutive patients attending a teaching hospital IBD clinic over a consecutive 6-week period. All patients had an endoscopic, radiological and/or histological diagnosis of IBD.

Results

280 questionnaires were distributed and 274 analysed (3 incomplete, 2 not returned, 1 no sexual activity). 167 female (median: 46 years, range 17–81 years) and 107 males. Two males disclosed RAI and were used as a control. Of the 167 females, 96% were heterosexual, 2.4% were same-sex partners and 1.2% were bisexual. 14% had a history of RAI—this group had more previous STIs (40%) versus those with no history RAI (5%) (p<0.0001; relative risk (RR) 13.41). Chronic rectal pain was more frequent in women with RAI (RR 2.4; p≤0.03). No difference in rectal discharge (RR 1.75; p=0.72) or bleeding (p=0.3).

Conclusions

This is the first report of sexual behaviours in a non-genitourinary medicine clinic; giving a unique insight into sexual practices in a cohort of patients with IBD. A past history of STI and RAI can identify risk and we propose testing for those with a history of STI, RAI, men who have sex with men and women aged under 25 years.

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