Search Results (3)

Men who have sex with men (MSM) in sub-Saharan Africa (SSA) are disproportionately affected by the human immunodeficiency virus (HIV) compared to adult men in the general population. Unprotected anal sexual intercourse is a high-risk behavior for HIV infection. This makes the correct and consistent use of condoms with condom-compatible lubricants crucial in reducing further HIV acquisition amongst the MSM population in SSA. However, consolidated data on the scope of the consistency of condom use with lubricants among MSM in SSA is lacking. In this regard, it was necessary to consolidate existing evidence on consistent condom usage with lubricants, as well as associated context-specific factors among the MSM population in SSA. A systematic review was conceptualized and registered with the International Prospective Register of Systematic Reviews (registration number: CRD42023437904). It was compiled following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) principles and guidelines between July 2023 and June 2024. We searched PubMed, Scopus, ScienceDirect, Google Scholar, and governmental and non-governmental institutions to find published and gray literature relevant to the review objectives from 2005 to June 2024. Studies conducted in SSA, published in English, focusing on MSM aged ≥15 years and also reported condom and lubricant use were considered for this review. Following the removal of duplicates and ineligible articles, 40 studies out of 202 reviewed were selected for the study. The most common study designs were cross-sectional surveys (n = 32) followed by prospective cohorts (n = 4), integrated bio-behavioral surveillance surveys (n = 3), and intervention studies (n = 1). Of the 40 eligible studies included in this review, half (n = 20) reported consistent use of condoms but without lubricants, three reported consistent use of condoms with lubricants but did not specify the lubricant type, six reported consistent condom use with water-based condom-compatible lubricants, and 11 reported only condom use but not consistent usage. Factors linked to consistent condom use with lubricants among MSM from various studies included higher educational level, knowing one’s HIV status, accessibility challenges, and older age. Having a high level of self-worth and HIV risk-reduction counseling was also associated with a consistency of condom use amongst MSM who engaged in receptive anal sex. This review indicates that only a few studies reported consistent condom use with lubricants and water-based compatible lubricants. Full article

Anal canal duplication (ACD) is a very rare condition, diagnosed and treated mostly in childhood. Less than 90 cases have been reported in the literature so far. We are presenting a case of a young woman who underwent surgical excision of the duplication when she was 27 years old. The patient was unaware of her condition and was referred from a gynaecological office to the surgical department with a history of perianal discomfort and mucus discharge. Local examination showed an external orifice posterior to the anal opening, on the median line, which had the macroscopic appearance of a secondary anal orifice. The opening was about 0.5 cm in diameter. Exploration of the tract revealed a length of about 4 cm. MRI described the aforementioned tract, parallel to the anal canal, with no other anomalies mentioned. Under spinal anesthesia, with the patient in jackknife position, the accessory anal canal was surgically excised. The pathology report showed the presence of smooth muscle fibers and typical anal glands in the specimen. After a five-year follow-up, the patient showed no recurrence or any other related local symptoms. Absence of perianal abscess from the patient history, along with the macroscopic aspect of the opening similar to a secondary anal orifice on the midline, should raise the suspicion of ACD. Due to the lack of bothersome symptomatology, the patient did not seek any special investigations for her condition until she was in her late twenties. ACD is a very rare condition in adults that might pass unnoticed, but a midline opening posterior to the anus should always raise the suspicion of a secondary anal canal. Surgery is the only cure for this condition with good results after a proper pre-operative workout to reveal others simultaneous malformations. Full article

Background and Objectives: Caudal duplication syndrome is a rare association of anatomical anomalies describing duplication of the hindgut, spine, and uro-genital structures, leading to varied clinical presentations. The current literature focuses on case reports which describe the embryological etiology and anatomical spectrum of the condition giving little attention to the surgical preparation, the need for a well-structured follow-up program, or the transition into adult healthcare of these complex patients. No reviews have been published regarding this complex pathology. Materials and Methods: A review of caudal duplication syndrome cases was done to assess the range of the clinical malformations, timing, and types of surgical interventions. Inconsistencies in multidisciplinary care, follow-up, and risk events were described. Results: Hindgut duplication always involved the anorectal region. Anorectal malformations were evenly distributed as unilateral and bilateral. Colon duplication extended from the anal region to the transverse colon or ascending colon in most of the cases and less to terminal. In females, genital duplication was present in all cases. The follow-up period varied between 3 months and 12 years. In all adult females, the motive of presentation was related to pregnancy (complications after successful delivery, fertility evaluation) or late complications (fecalith obstruction of the end-to-side colon anastomosis, repeated UTIs with renal scarring). Conclusions: Complex malformations affecting multiple caudal organs may have a strong impact in many aspects of the long-term quality of life; therefore, patients with caudal duplication syndrome need increased awareness and joined multidisciplinary treatment. Full article