Treatment of peri-anal abscess: It is not difficult to make the clinical diagnosis of perianal abscess. All patients with acute or chronic peri-anal condition must be thoroughly evaluated and per rectum done routinely. Peri-anal abscess may extend depending on the immunological status of the patient; therefore early treatment is mandatory to avoid this and more serious morbidity. If patients require surgical incision, it should be done promptly on first visit, or referral made if the surgery is unavailable. Otherwise, broadspectrum antibiotics such as amoxacillin-clavulanic acid (augmentin) alternatively amoxacillin or ampicillin must be administered in sufficient dose for at least 10 days. Palliative care including Sithz baths and analgesics are also important. Ultimately these patients are enrolled in chronic HIV care. 2.4. Peri-anal and/or genital herpes: Latent or active infection with HSV I and II are common in the general population, and is usually mild in immunocompetent persons. Severe cutaneous disease or visceral involvment is usually restricted to patients with advanced immunosuppression with a CD4 count <100 cell/mm3 The lesions become extensive, persistent, severe and sometimes bleeding. Unless thorough evaluation with regular inspection of genital and peri-anal areas is done, patients very often donâ&#x20AC;&#x2122;t complain about genital lesions. The response to Acycovir is gratifying if it is done in sufficient dose (400mg 4 to 5 X/d) and sufficient duration (10 days to 2 weeks in moderately severe or severe cases). IV Acyclovir may be administered for severe mucocutaneous disease or visceral involvement (5mg/Kg IV 8 hourly for 2 weeks, switched to oral with evidence of clinical improvement). There is risk of recurrence with severe immunodeficiency. In such cases repeat treatment and put patient on chronic HIV care including ART. Herpetic oro-labial infection is treated the same way as ano-genital herpes. The treatment of anal and genital warts is particularly frustrating when they are large. Unlike other opportunistic infections the response to ART is not satisfactory. Patients who have very well responded immunologically with ART continue to suffer from the warts. Depending on the size,cauterization, podophyllin treatment and surgical debuking, etc may be tried. Patients are referred to where these services are available.
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