Unusual case of a rectal tumour.

A 48-year-old man presented as an emergency with a 3-week history of rectal bleeding. Examination of his rectum revealed a circumferential tumour, 2 cm from the anal verge. An MRI scan reported a locally infiltrative mid-lower rectal tumour staged as T3d/T4 N2 MX. A colonoscopy revealed appearances of severe proctitis and biopsies did not show any evidence of dysplasia or malignancy. The patient was discussed at the regional colorectal cancer multidisciplinary team meeting with a management plan for neoadjuvant chemoradiotherapy following repeat biopsies, which were again negative for malignancy. He tested positive for the HIV and was referred to genitourinary medicine. A positive Chlamydia trachomatis nucleic acid test from a rectal swab was serovar L2 consistent with a diagnosis of lymphogranuloma venereum. He was treated with doxycycline and subsequent MRI scans showed reduction in tumour size with eventual resolution. This case report highlights the importance of HIV testing in patients with newly diagnosed colorectal tumours.

Sexual health in adolescents.

Young people are particularly vulnerable to poor sexual health outcomes of high rates of sexually transmitted infections (STIs) and unwanted pregnancy. They partake in riskier sexual behaviors with higher rates of sexual partner change and poor levels of contraception, including condom use. Access to services may be limited either through lack of appropriate services or disinclination to seek out services. We review the biological, cognitive, behavioral, and socioeconomic risk factors that contribute to their poor sexual health outcomes. Details include the epidemiology, presentation and complications of STIs and pregnancy in adolescents, the clinical assessment of adolescents, contraception options, confidentiality, consent and safeguarding, and key characteristics of successful adolescent services.