[Question #11811] Rectal pain after exposure - help!

12 months ago

I am 35M and received deep unprotected anal rimming from a man on Tuesday 6 August. He also rubbed his penis against my anus but this was extremely brief (like 1-2 seconds) and it was not inserted. No other sexual acts.

On Thursday 8 August I felt a heavy pain/pressure in my rectum/anus. The best way I can describe it is a tension headache feeling in my butt. It is pretty much constant and I can't figure out what makes it better/worse. It tends to be worse when I am sitting a long time and/or am holding the need to urinate. It has now been one week and the pain has not subsided. It is not bad enough for me to stop my day-to-day activities; it is a dull and annoying pain and it comes and goes - although it is there maybe 80-90% of the time. I feel like my anus may also be a little more itchy / moist than normal too. I do have a history of anal fissures but they have never caused this kind of pain, they usually cause a sharp/glass like pain when passing stool. This pain does not get any worse or better when I pass stool; however, my stools are definitely looser and more watery than normal so I think whatever is going on is linked to that.

On Saturday 10 August I went and tested for HIV (5th Gen), Syphilis, Gonorrhoea and Chlamydia (the last 2 were tested from rectum, throat and urine samples). All tests returned negative.

It seems too much of a coincidence to me that this pain has come out of the blue so soon after this encounter. Did I test too soon or (if the pain was due to one of these STIs, namely Gonorrhoea/Chlamydia) would my test have returned positive? Do you recommend any other STI testing for this symptom and exposure? I know you are not general doctors, but do you have any other ideas - I'm also extremely worried now about colon cancer thanks to Dr. Google.

Thanks for any advice you can share.

Edward W. Hook M.D.

12 months ago

Welcome to our Forum and thanks for your questions. I'll be glad to comment. The activities you describe are rather low risk for STIs and the symptoms you describe are consistent with a local process. They certainly do no suggest rectal gonorrhea or chlamydia and your results are reliable and prove that these infections were not present. Syphilis is typically painless. Herpes might cause such symptoms and rectal HSV can be acquired from receipt of oral sex if you have not already got HSV-1 (perhaps manifest as cold sores). FYI, this is rather unlikely to be rectal HSV as over 60% of the population already has HSV-1, even though most people do not know it. What you describe sounds like a local process and I think it would be important to have a knowledgeable clinician take a look. I would wonder about non-STI causes such as hemorrhoids as well.

I hope this perspective is helpful. I think the most important thing you can do is get yourself seen by a knowledgeable clinician. As gastroenterologist would be best although a your PCP would also be a good place to start.

EWH

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12 months ago

Would 2 days not be too fast for herpes? In any event I don't see or feel any sores. This is more like an aching pain.

I meant to add that about one hour before the rectal swab I used tea-tree oil wipes and I'm worried that they could have given a false negative if the tea-tree oil temporarily killed some of the bacteria? Does that make any sense or are my rectal tests are 100% accurate? Why do many websites say tests for Gonorrhoea and Chlamydia are not reliable until 7-14 days after exposure - or is that only if you have no symptoms?

I will schedule a GP appointment if things don't improve but I know for sure my GP will think it's a STI once they know my sexual orientation so I want to be sure I am comfortable to have crossed out STI risks before.

Edward W. Hook M.D.

12 months ago

On average, HSV lesions appear about 5 days after an encounter and always within 10 days. 2 days is rather fast.

I presume your gonorrhea and chlamydia tests were PCR-type nucleic acid amplification tests (NAATs) which do not require living bacterial to be positive. I have no idea whether tea-tree oil might intervere with the tests or not but again, the symptoms you describe are not those typical of gonorrhea or chlamydia. The 7-14 day "window" is, unfortunately, internet misinformation

Understood regarding your concerns about your PCP. EWH

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