[Question #6184] Anal STD/fissures/proctitis?

18 months ago

Thanks for considering my predicament. Before I see my primary care physician I could use some perspective.

I am a bisexual man. I received anal intercourse roughly six weeks ago from another male--very stupidly without lube. At the time I noticed it hurt more than usual, but chalked that up to the lack of lube and given (limited) prior experience I believed that the soreness I felt afterward would dissipate. It largely did, however, about a week afterward I began to feel a strong aching feeling at the perineal end of my anus (toward my testicles), and bowel movements became quite painful. Using a mirror I checked things out and found a quarter-sized area of raw, red skin inside my anus, between two visible fissures--one roughly at 11:00 and the other at 3:00, if that makes sense. The red area of skin is very moist, like sweat. While this area hurt for the first few weeks, it no longer does.

Fearing the worst, I had an online consultation with a physician who prescribed zithromax and keflex together in case of gonorrhea or chlamydia. I took them together as directed and the area in question did not change in the slightest. While the raw/red area has not grown or shrunk over these last few weeks, I'm troubled by the fact that nothing has changed. Can I rule these STDs out?

I also wondered if the red area could be fungal, and dabbed a hydrogen peroxide wipe on it. It temporarily turned white...but nothing ultimately changed. I also know that hydrogen peroxide can kill healthy skin cells, so I stopped.

As for the fissures, I am being very careful with bowel movements and do feel sometimes feel pain--like skin stretching (duh)--when I have a bowel movement. I've lost about 5 lbs since this all started--for obvious reasons this is all killing my appetite.

I guess my main question is about the red, raw skin area, the appearance of which doesn't seem to change. Is the ongoing redness and the moisture just my skin (slowly) healing? Ho Is there anything I can do to speed this up?

H. Hunter Handsfield, MD

18 months ago

Welcome to the forum. Thanks for your question.

Of course I cannot diagnose the problem and will not try. But putting together all you say, I suspect you have one or more traumatic anal fissures. However, herpes is a possibility, and syphilis always is a consideration for genital or anal ulcers. However, syphilis is unlikely because of the speed of onset (usually 10-20 days for initial syphilis chancre) and because the gonorrhea/chlamydia treatment would have cleared it up. That treatment wasn't wise -- there was little chance of gonorrhea or chlamydia causing this sort of problem, but it probably didn't hurt anything and indeed would have cured either of these. (Probably it was azithromycin and cefixime, not cephalexin [Keflex], which doesn't work well for gonorrhea.)

So the only realistic STD possibility is herpes. I doubt it, both because of the likely trauma association and initial herpes usually would also have external blisters or ulcers. But it's something to discuss with your doctor. A fungal infection also doesn't seem likely.

So keep your appointment and see what your doctor says. In the meantime, you should avoid any attempts at treatment. Keep the area clean (soap and water wash a couple times a day, if not too painful); if serious pain continues, you could use an anesthetic ointment like benzocaine or lidocaine. But for sure no antibiotic or antifungal creams, and no hydrocortisone or other steroids (typically sold as anti-itch creams and ointments).

I'll be interested in the outcome after you've seen your doctor. I hope these comments are helpful in the meantime.

HHH, MD

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18 months ago

Thanks so much, Dr. Handsfield. This gives me peace of mind. You're right, the second antibiotic was cefixime, not keflex--my mistake. I will follow up once I've seen my PCP.

H. Hunter Handsfield, MD

18 months ago

OK, glad to hear the discussion so far has been helpful. I look forward to hearing the outcome of your PCP visit.---