Anorectal Exposure

[Stayfit823]

Doctors:

Over the past few months I have experienced off and on anal itching.  As I looked online for possible causes I learned that anal gonorrhea can be a symptom of anal itching. A little over 1 year ago I did have various sexual relations with men where they rub the head of their penis around my anus but did not insert into the rectum so my questions are as follows:

1) Is it possible to contract anal gonorrhea without insertion and thus just from potential precum around the outside anus area?

2) I have read in posts that gonorrhea eventually cures itself, thus given the time since potential exposures would it even be possible to have an infection or would immune system have cleared the infection out?  Since throat gonorrhea often has no symptoms, same deal clears itself without ever knowing infected?

3) If aysmptomatic or minor systems is their any real health harm (other than potential transmission to others) to men that might have anorectal gonorrhea as I understand it cannot spread to other areas?

During routine physical last fall was tested for all STD's but neither throat or anus swab, thus the concern.

Thank You

[Edward W Hook, MD]

As time goes on more and more infections cure themselves without therapy.  EWH

[Stayfit823]

Dr Hook:

Thank you for your quick and informative response.  

I did not completely understand one part of your reply... you state 'the rate at which clearance occurs tend to increase over time'  I am sorry, not sure what that means......

[Edward W Hook, MD]

Before I address your questions, let me state that without penetration there is no risk to you of acquiring gonorrhea  or, for that matter, any other mucosal STD such as chlamydia.  Rectal itching is a very non-specific symptoms which can be due to many, many non-infectious causes.  Thus your intermittent symptoms are not a reason for concern.  As for your specific questions.

1.  No, penetration is needed.  The organisms need to be "delivered to the potential site of infection for effective transmission.
2.  You are correct, a number of observational studies and clinical observation have demonstrated that many persons who have both gonorrhea and chlamydia and are not treated are found no longer have the infection when they return for treatment.  Most of these observations have been made in -persons with genital infections but there have been similar observations made for both throat and rectal infections as well.  The rates at which this clearance occur tend to increase over time but because it would be un-ethical to formally study these events and because when persons are aware that a patient is infected they should do all possible to insure treatment, the precise timeline is not well described.  
3.  Over transmission to others is the greatest concern.  For gonorrhea, it can rarely enter into the blood stream and cause a complication called disseminated gonococcal infection in which the bacterial circulate in the blood to cause a rash and joint pain. This is a very rare complication and not a major concern in most situations.  At the same time, as health care providers, we do not want anyone to have an infection present, be it asymptomatic or not.  It is for this reason that we suggest that all clients inform their health care providers of all sites of sexual exposure and that health care providers test their patients at all sites of exposure as well.

I hope these comments are helpful to you.  With regard to your specific situation, there is little to worry about.  The exposure you describe did not put you at risk for acquisition of infection.  Take care. EWH