title: Redefining urological history taking - anal intercourse as the cause of unexplained symptoms in heterosexuals.
abstract: BACKGROUND
  Symptoms suggestive of genito-urinary infection are frequent reasons for visits to general practitioners and account for approximately 15% of referrals to out-patient urology. The symptoms may be non-specific, and patients can undergo multiple investigations in an attempt to identify a cause.
  
  
  METHODS
  We have seen several such patients, all of whom had engaged in unprotected heterosexual anal intercourse prior to the onset of their symptoms. Presenting complaints included urethral discomfort, acute epididymitis resistant to standard antibiotics, and sudden onset of overactive bladder symptoms.
  
  
  RESULTS
  These patients illustrate the importance of careful history taking. Whilst some questions may be difficult to ask, they may reveal precipitating factors that the patient will be reluctant to volunteer. The repetitive nature of the behaviour may explain the chronicity of symptoms experienced by the patients, and avoidance of this activity may be the only management needed to improve them. For those with infective symptoms, the clinician's choice of antibiotic can be altered to provide anaerobic cover.
  
  
  CONCLUSIONS
  A history of anal intercourse should be sought in patients with unexplained genito-urinary symptoms.
authors.affiliation: Department of Urology, Guy's Hospital, London, UK. nquatan@hotmail.com
authors.forename: Nadine
authors.initials: N
authors.lastname: Coull
authors.forename: Heleni
authors.initials: H
authors.lastname: Mastoroudes
authors.forename: Rick
authors.initials: R
authors.lastname: Popert
authors.forename: Timothy S
authors.initials: TS
authors.lastname: O'Brien
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D017280:Condoms / Q000706:statistics & numerical data; D005260:Female; D052776:Female Urogenital Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D020010:Heterosexuality / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D052801:Male Urogenital Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D008487:Medical History Taking / Q000592:standards*; D012307:Risk Factors; D012725:Sexual Behavior; D012747:Sexual Partners
chemical_list: D000890:Anti-Infective Agents