[Question #5701] Rectal Gonorrhea worry

19 months ago
Hello Doctor,
 I recently had Condom protected receptive anal sex with another man on June 24th. (I always use Condoms) 
The condom was worn the whole time and did not break. (I inspected afterwards) He stated that he always uses condoms and is negative for everything. 
About 11-12 days later, I was having difficulty having a bowel movement ( it was a hot day and I think I was dehydrated) while moving my bowels, I felt a tear and a good deal of pain in my rectum. There was swelling the next day and some blood when I wiped. About three days after this I noticed a bit of yellow discharge in my stool and as I wiped but no more blood. Now that it is July 14th the condition has improved but bowel movements are still a bit painful. I have used preparation H and that has helped. I haven’t had any further blood in my stool or when wiping since last week.  The swelling and pain have abated except when I have a bowel movement. 
If this was a gonnorhea infection I wouldn’t think there would be any marked improvement in my condition without treatment.  
Given the timeframe, I understand that Gonorrhea usually shows symptoms in either the penis or rectum in about 3-5 days, that being said, condoms were used and I didn’t have this condition until about 11 days later. Is it possible this is a gonorrhea infection and the symptoms showed up late? Or, it is mostly likely just a fissure from the difficult bowl movement causing this?  I have read that both hemroids and anal fissures cause a mucous discharge from the rectum. Is that correct?  Am I simply overthinking this because of a sexual encounter that I deeply regret? It was the presence of a mucus discharge that sent my anxiety into overdrive. I am due for an HIV blood test next week which would be about 31 days later. Would you recommend I get tested for gonorrhea as well? 

Edward W. Hook M.D.
Edward W. Hook M.D.
19 months ago
Welcome to our Forum and thanks for your question.  Congratulations a well on your commitment to safe sex.  from what you say, your partner shares your commitment to safe sex and your condom use should have prevented acquisition of STI.  From the sounds of things, your recent symptoms are more due to your constipation and difficult bowel movement than any STI. Your symptoms and your recent improvement without therapy are more suggestive of hemorrhoids or a fissure (also, FYI, rectal gonorrhea is most often asymptomatic).  Having said that, when you go for your HIV test as planned, my advice would be and go on and have a gonorrhea test performed as well.  While I do not think you are infected and suspect that your test will be negative, I also think you will feel better with a negative test.

I hope that this assessment is helpful.  Please don't worry.  EWH