Rectal itching / STD related?

[Turner1]

I am a 28 year old heterosexual male - about 5-6 years ago I had sex with several partners in college, unprotected.  A month or two after I noticed a red dot on the head of my penis, not much larger than a pin *****.  The dot stayed there for several weeks and then went away.  Another tiny red dot then appeared and then went away a few weeks later.  There was no itching or scabbing, etc. and I never went to the doctor or got tested for anything.  A few months after the red dots went away (they never came back), I began to have moderate to significant itching in the anal / rectal area.  For the past five years I have had this itching.  It comes and goes but normally I won't go a few days without feeling significant itching.  I went to a rectal dr. last year and he diagnosed it as Puritus Ani, and recommended some creams and a hygene regime.  This did not help much and to begin with I am already hegenic and have a very good diet and am in good health. I've tried every cream / ointment in the book and they usually only cover up the itching for a brief period.

Also when I apply creams (such as Desitin or Prep. H) I can sometimes feel very small bumps around and sometimes inside my anus.  These stick around for maybe a week or two and then go away or emerge in other part of the anus.  There will often be one or two bumps on the inside.  I also occasionally have itching on the base of my penis and scrotum, though there has never been any redness or sores since the first red dots, just sudden itching that happens once or twice a day but doesn't last.  I am now married and we just had a baby - she has been tested for most STD's and all tests were negative - I have been tested for syphilus and AIDS which were also negative.  She has mentioned that she also had anal itching but figured it was hemmorhoids.  I am wondering if I could have passed something to her years ago and she is having the same symptoms.  I'm wondering if it could either be some form of genital warts and/or herpes that is constantly breaking out in my rectal area that is causing the itching, though my wife has been tested for those so it doesn't make sense to me.  Over the past 5 years there has literally not been a break (more than a few days) in the itching.

Here are my questions:

-Are these symptoms consistent with a particular STD?  If so is there any cure / effective treatment?

-Have there been instances where an STD can move from the penis to the anus without any anal contact (I've never had any anal sexual contact of any kind)?

-What kind of doctor should I go and see to get this diagnosed / treated (STD doctor, rectal doctor, etc)?

Thanks!!!

[H. Hunter Handsfield, M.D.]

Sounds like you have garden variety pruritus ani.  Sounds fancy, but it's just Latin for itchy anus--and you already knew that!  Everybody has pruritus ani sometimes and some people are plagued by it more frequently.  Sometimes a specific cause can be found, such as yeast infection, anal fissure, or hemorrhoids.  Other cases probably are related to hygiene; wiping carefully after defecation and showering/bathing daily with careful washing of the anal area often are the only required "treatment".  Topical steroids, like hydrocortisone, often help--but sometimes can make things worse, especially if there is a yeast/fungal infection.

The only conceivable STD problems are herpes and HPV/warts.  Herpes would be intermittent, not continuous; i.e. symptoms for several days, with no symptoms at all for several weeks or months, then recurrence.  And HPV/warts rarely would persist this long, and undoubtedly you would have noticed the bumps on your anus.  The chance of either of these is zero or close to it.

The bottom line (pun not really intended, but not avoided either!) is that you should see a health care provider.  A general provider--family medicine, primary care internist, etc--is most appropriate.  In the meantime, put STDs out of your mind.

Good luck-- HHH, MD

[HHH,MD]

For reassurance about HPV, I should have added that warts cannot come and go over a week or two.  The "bumps" might be areas of local tissue swelling due to inflammation.

Don't let embarrassment etc to delay making an appointment with your health care provider.  It's a very common problem and you can be sure s/he has dealt with it quite frequently.

HHH, MD