Going straight to your main question, your rectal gonorrhea probably has not recurred. It isn't impossible, but very unlikely following what sounds like standard treatment with ceftriaxone (the injection) and either azithromycin (if the pills were single dose) or doxycycline (twice daily for a week).

Assuming your intitial infection was documented by proper testing, i.e. a possitive nucleic acid amplification test (NAAT), then for sure you had gonorrhea. However, it was not necessarily the cause of your symptoms at the time. Proctitis -- inflammation of the rectum -- has many causes, both sexually acquired and others, and although gonorrhea can cause severe procitits, usually it does not; most cases are asymptomatic or have only mild symptoms. Accordingly, it is possible you had proctitis due to something else and gonorrhea coincidentally present. The treatment you had, especially doxycycline or azithromycin, could have temporarily suppressed some of the other possibilities. (By the way, I agree analingus is a rare source of anal gonorrhea; in my 40 years in the business, I don't think I've ever seen it. If you had any other anal exposures in the several months before diagnosis, one of those events might have been the source. But if the analingus event is the only option, there is no reason it cannot occur on rare occations.

At this point, it is important you be professionally evaluated by an expert who understands STDs and proctitis. Your rectum should be tested for chlamydia, including the form called lymphogranuloma venereum (LGV), syphilis, and herpes, as well as repeat testing for gonorrhea. If none of these pans out, you probably should be evaluated for inflammatory bowel disease, i.e. ulcerative colitis/proctitis and regional enteritis (Crohn's disease). As implied above, I would be very surprised if gonorrhea is found again. I have no way to judge the likelihoods of the other possibilities mentioned, although I would point out that herpes is a more likely infection from analingus; tends to cause severe proctitis; and often recurs. Try to get evaluated in the next couple of days -- the sooner the better for accurate herpes testing in particular, and for effective treatment if it turns out to be herpes. (That said, I'm not really predicting herpes as the cause -- the other causes remain equally plausible.)

Thanks again for your question. I'll be very interested to hear how this turns out.

Best wishes--  HHH, MD

Just to give a bit more information - I'm very young, healthy and straight and have never had any bowel movement issues and never did ANYTHING sexually with the anus prior to that one time having the escort perform oral-anal on me,  so to have the proctitis symptoms start a few days immediately after that incident was why, I'm assuming, the doctor decided to give me the gonorrhea treatment (even though it would have been so rare to acquire it that he thought it was a false positive). I did the rectal swab test and tested negative for chlamydia and positive for gonorrhea. 

I'll talk to my doctor immediately to get tests for LGV chlamydia, herpes, syphilis and gonorrhea. 

I'm jsut extremely frustrated that something like herpes and gonorrhea is even possible because I read the STD charts before seeing the escort and it wasn't listed even as a known possibility: http://www.sfcityclinic.org/stdbasics/stdchart.asp.

I don't want to take up to much of your time but I guess a follow-up question to what you've stated is: if it was herpes, would the ceftriaxone  and azithromycin fix the herpes outbreak and return me to normal like it did or was that purely coincidental? And do I need to use protection for penis-vagina sex with my SO?

I am unaware of any formal research anywhere on analingus risks for transmission of any STD. Those listed in the city clinic chart are logical but no data are available.

There are plenty of resources in San Francisco for the sophisticated care you need, every bit as good as we would do, including the city STD clinic. In any case, I no longer have an active practice.

As for unprotected vaginal sex with your partner, I see little risk. OTOH, it isn't all that rare for herpes to involve more than one anatomic site, and maybe for infectious virus to be in the anal area externally during an active rectal infection. If I were in your situation, I would hold off at least until I had been examined, if not for lab test results.

Went to the city clinic first thing in the morning and got blood tests for syphilis and herpes 2, and anal swab tests for herpes 1 and 2, chlamydia and gonorrhea.

The nurse there did an anoscopy and didn't see any lesions, or notice any bleeding (my doctor didn't see either of these the first time I had the more severe proctitis outbreak either) but I do believe that she saw inflammation. She said that it would definitely be rare for it to be herpes without any rectal pain, lesions or bleeding but she wasn't sure.

Without any active lesions in the anus or penis, would I still be infectious if I do penis-vagina sex?

Also, I should have the full test results back within 5-7 business days so I'll update you the minute I get it.

Thanks for all the help.

My test results came in today and I'm negative for rectal gonorrhea, chlymidia, PCR herpes test and the IGG HSV2 test. 

I'm pretty confident I don't have HSV2 in the rectum but could it be possible that I have HSV1 as I didnt have any visible lesions and this is outbreak #2 so I'm not sure how accurate the PCR test would have been. 

So while I cannot rule out past gonorrhea or recurrent herpetic procititis, my guess is that this problem has nothing to do with your sexual exposure a few months ago, just coincidence -- and that you have a limited form of inflammatory bowel disease of the rectum, i.e. ulcerative colitis or Crohn's disease. If your current symptoms clear up entirely, it shold be safe to continue to sit on the problem (pun slightly intended), but if there is a recurrence, then you should immediately (within a day or two) see your personal physician and/or a gastroenterologist. Both HSV testing and visual diagnosis (by anoscopy or proctoscopy) will be most accurate the sooner they are done.

Best wishes.