Chronic Diarrhea: Considering STIs and HIV in MSM

The document emphasizes the importance of considering sexually transmitted infections (STIs) and HIV as potential causes of chronic diarrhea, particularly in men who have sex with men (MSM). In 2019, Public Health England recorded 77% of all sexually transmitted shigella and 37% of all lymphogranuloma venereum (LGV) diagnoses as being in the MSM population. The author criticizes the lack of sexual history taking in medical practice, which can lead to inaccurate risk stratification. In the UK, it's estimated that almost 10% of HIV positive individuals are unaware of their status and about 50% are diagnosed late. Chronic diarrhea is listed as one of the symptoms most associated with HIV infection. The author suggests that a full sexual history and STI testing could be a cost-effective way to diagnose the cause of chronic diarrhea, potentially avoiding the need for more expensive and invasive investigations. The author calls for normalizing HIV testing in both primary and secondary care to decrease late and unknown HIV diagnoses.