Objectives:To determine the prevalence of high grade anal intraepithelial neoplasia (HGAIN), the value of anal cytology in screening for HGAIN, and the characterisation of epidemiological factors and human papillomavirus (HPV) types. Methods: Prospective cohort study of HIV positive homosexual men. Subjects were interviewed, underwent STD, anal cytological, and HPV screening at enrolment and at subsequent follow up visits with anoscopy and biopsy at the final visit. 57 enrolled, average CD4 count 273 ×10 6 /l (10-588); 41 completed the cytological surveillance over the follow up period (181 visits, average follow up 17 months), 38 of these had anoscopy and anal biopsy. Results: Oncogenic HPV types were detected in 84% and high grade dyskaryosis in 10.5% (6/57) at enrolment. There was a 70% incidence of high grade dyskaryosis during follow up in patients with negative/warty or low grade dyskaryosis at enrolment. Anoscopy correlated with histology in high grade AIN lesions (sensitivity 91%, specificity 54%) and cytology was 78% sensitive (18/23) for HGAIN on biopsy. Conclusions: AIN and infection with multiple oncogenic HPV types are very common among immunosuppressed HIV positive homosexual men. Apparent progression from low to high grade cytological changes occurred over a short follow up period, with no cases of carcinoma. All 23 cases of HGAIN were predicted by cytology and/or anoscopy. Future studies focusing on the risk of progression to carcinoma are needed before applying anal cytology as a screening tool for AIN in this population. (Sex Transm Inf 1999;75:172-177)

Epidemiological data in 13 cases of sexual assault on men who attended a sexual assault referral centre are presented. All the assailants were male. The sexual orientation of the victims was predominantly heterosexual (7 of 13), 3 considered themselves to be homosexual and 3 were confused about their sexual orientation. The average age at the time of assault was 21.6 years. The most common form of assault was anal intercourse which occurred in 8 cases, followed by forced oral penetration which occurred in 6 cases. The proportion of known:unknown assailants (8:5) shows similar characteristics to those seen in female rape, use of weapons and multiple assailants were more common in assault on men. Seven men (54%) developed psychological problems following assault, and this was their main reason for presentation to the centre.

Objectives: To describe the features of an outbreak of early syphilis in North Manchester. Methods: Retrospective KC60 and case note review. Results: In a 25 month period, 10 cases of primary, 22 of secondary, and nine cases of early latent syphilis were diagnosed. 39 were homosexual or bisexual men, 20 being co-infected with HIV. Most infections were acquired locally and in 19/41 cases oral sex was the only risk factor. High rates of unprotected anal sex were reported among the homosexual men and co-infection with other STIs was common. Conclusion: This outbreak will facilitate the spread of HIV in the homosexual male population. Unsafe sexual practice is common and the perception that oral sex is "safe" needs revisiting. Delays in accessing GUM clinic appointments must be addressed as part of the control strategy. (Sex Transm Inf 2001;77:311-313)

The development of an osteonecrotic (avascular necrosis) hip joint in a patient with symptomatic CDC Stage IV C2 disease is reported. The diagnosis was aided by radiological assessment and confirmed by radioisotope bone scan. This case serves as yet another musculoskeletal manifestation in association with HIV infection.

Epidemiological data and rates of sexually transmitted diseases (STDs) are presented from a group of 90 women screened following rape. Forty-eight (53%) women knew their assailant. In 6 cases multiple assailants were involved. In 21 (23%) rapes weapons were used. Of 47 women examined within 48 hours of rape, 17 (36%) had evidence of genital trauma. Anal injury was common (8 of 11, 73%) in those reporting anal intercourse. Anal assault (17 of 90, 19%) and oral assault (16 of 90, 18%) commonly accompanied rape. STDs were diagnosed in 13 (14.4%) women, 3 having mixed infections. Neisseria gonorrhoeae was isolated in 2 women, Chlamydia trachomatis in 7, Trichomonas vaginalis in 6, genital warts in 2 and Pediculosis pubis in 2 women. Five of 16 cervical cytology results showed abnormalities, 2 were suggestive of CIN. Eleven of 13 women with an STD (84.6%) had been sexually active within the 3 months prior to the rape. Previous sexual activity may be the most relevant factor determining those most at risk of harbouring an STD.