
Hello. I%E2%80%99m A 36yo Male. For The Last 2 Months


I tought it could be haemorroids, altough I have no blood, so started taking flavonoids and diosmin (Daflon in my country, used to treat vascular problema including haemorroids) and it sucessfully treats the pain, but as soon as I start to discontinue the medication the pain returns, sometimes stronger.
I am worried it could be gonorrhea.
One year ago I tested for all STDs, all negative except gonorrhea in the urine (naat, pcr). I took cefixime azithro, and gave the same to my wife (who didn%E2%80%99t have symptoms or signs of it).
15 days later we resumed sexual activity and I tested 3 times after finishing the treatment, also with naat/pcr, 1, 2 and 3 months after, always negative. I didn%E2%80%99t have any other sexual partners im the meanwhile.
Also, I never had receptive anal sex in my life.
Sometimes on the toitet, I would clean the tip of the penis and then the wipe the anus with the same toilet paper (bad idea I know).
My main question is. Could I have contaminated mysef with the toilet paper and the antibiotics treated the urethral infection but not a possible anal infection?
I intend to do rectal exams as soon as possible but, since me and my family work in health department and know most doctors and health workers arround, didn%E2%80%99t want to test before hearing an expert opinion, so I am not caught with an std like that.
Gonococcal proctitis is unusual in men without anal penetrative sex.
Detailed Answer:
Hi,
Welcome to ASK A DOCTOR through HCM
Thanks for posting your query.
I understand your problem, but not the thing used by you %E2%80%99t or 99m.
Rectal Gonorrhea is almost not possible without anal sex especially in men. Outer aspect of the anus and perianal area are lined by stratified squamous epithelium which is highly resistent to bacterial infection whereas inside rectum it is lined by Columnar epithelium which is succeptible for bacterial infection. Gonococcus is not a motile organism. So it is very much unlikely to get a gonococcal proctitis through toilet paper used to clean your penis. Have you anytime profuse urethral discharge and cleaned with the toilet paper which was also used to clean anus?
Usage of toilet paper before or after the gonococcal treatment?, as after treatment, it is unlikely to have infectious material on the tip of penis.
Moreover lower abdomen pain is also unusual with gonorrhea in men. Anyhow proctoscopy and culture and sensitivity for gonorrhea from the anal discharge can lead to the diagnosis. If the lower abdomen pain is present, Ultrasound examination will help. You have to meet your surgeon and get examined. Rectal STI is unlikely in the absence anal penetrative sex.
DR S.Murugan


I never had the usual symptoms, no urethral discharge that was noticeable or burning when urinating, only inflamation, but I always used the paper to clean the penis after urinating and then sometimes used to wipe the anus if that was the case, even when I was infected and didn't know about it.
Since I have anal/rectal pain and itching, the feeling of passing somethin in the anus (sometimes small portions of feces that don't even stain underware, other times something liquid also in small portions), no pain with bowel movements and actual relieve with bowel movements, some lower abdominal disconfort/distention, I can have diarrhea and constipation in the same day, no blood or fever, and relieves with flavonoids, do you have any preliminary sugestion?
I don't think the symptoms are compatible with much, besides proctitis.
Also, let's suppose it is contamination with gonorrhea, since it was treated at the same time, could the anitbiotics treat the urogenital infection but not the anal infection?
I did 800mg cefixime + 1g azithro.
Thank you
Your symptoms are unlikely to be due to Gonorrhea.
Detailed Answer:
Hi,
Welcome back.
Subclinical Gonorrhea (without any symptoms) is very rare.
Without the presence of obvious urethral discharge, it is quite unusual to be got autoinoculated into anus or rectum.
Your symptoms are quite unlikely to be due to gonococcal proctitis. May be due to irritable bowel syndrome. Consult your doctor and get well soon.
You are correct, the treatment for gonococcal urethritis would not be adequate to clear the gonococcal proctitis.
Dr S.Murugan.

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