Question

Greetings. Six months ago I developed some rectal ulcers. A colonoscopy was performed and although the biopsy didn't show any STDs or cancerous cells, the ulcers are still there after several months. A treatment against herpes was started with no success even when(biopsy didn't show herpes either). 3 treatments with antibiotics has been used along with proctofoam. They seem to work or at least diminish the symptoms, but in the ned the ulcers are still there. I recently acquired HIV (November 2005) and although my numbers are great and improving without medication (I only take natural supplements), one of the doctors proposed that the origin of the ulcers (that were never there before) could be related to the HIV infection. I wonder if you have seen any cases like this or if you could recommend some healing supplements or alternative procedures to treat the rectal ulcers. Thank you, Ulcer Guy

Answer

Thank you for your question.

It would be helpful to have some clarification as to where these ulcers are located. Are they truly in the rectum and seen on colonoscopy or sigmoidoscopy or are they localized to other areas such as the anal region or other parts of your intestinal tract. It would also be useful to know how big the ulcers are and how many are present. When you say that they are still there, is this based upon repeated endoscopic procedures? In addition, you say you acquired HIV in November 2005 is this actually when you think you were infected or when you were first diagnosed. If the latter, how long do you think you have been infected?. Finally, what is your T cell count and viral load? All of this information would be helpful.

From a diagnosis perspective the biopsy is key and if the ulcers are persisting and there was no diagnosis after the first biopsy it may be reasonable to biopsy again. There are many causes of rectal ulcers and this includes different infections such as herpes, cytomegalovirus (CMV) and even syphilis. Depending upon the appearance rectal inflammation can also occur with bacterial infections that can cause diarrhea such as salmonella, shigella and C. dificile disease and other more chronic infections such as histoplasmosis. Finally, there are also noninfectious things to consider depending upon the specific location and appearance of the lesions. This could include inflammatory bowel disease such as Ulcerative Colitis, Crohn's disease, and even aphthous disease which is common in the mouth but can be present throughout the gastrointestinal tract. In addition, certain types of cancer can present this way, although this seems unlikely if it has not changed in the last six months. I raise all of these possibilities not to alarm you but to make sure that you do pursue another thorough evaluation of these lesion.

As far as HIV itself causing rectal ulcers, I would think that would be unusual and would pursue the other causes partially outlined above.

Best, Eric