Bacterial Infection Via Anal Sex

[charliemerino]

Hey Doc. Just need some clarification. I recently (2 weeks ago) had unprotected anal sex with my new girlfriend. Prior to this I have not had any symptoms and my most recent episode of sex with another partner was 1 month prior (non protected). My symptoms started yesterday. No discharge, frequent need to urinate, or foul smelling urine. My only symptom was that it hurt when urinating and some time after for about a min (pain scale 2 out of 10). Other than that no other symptoms. Went to the ER and urinalysis was clean, and they swabbed me for possible STDs. Which will come back in 48 hrs (Monday). My only concern is that if my panel comes back clean from any STDs and the antibiotics they give me cure me of my symptoms, does my partner also need to go get a panel complete to check her for possible STDs (even though we have been monogamous)? And is it possible to contract a bacterial infection from anal sex and not contract an STD? I hope I got that all out ok for you to fully understand. I am not an STD expert, nor was the Dr. at the ER who treated me. Regards, Charlie.

[harshal84]

Thanks for a healthy discussion!
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[Edward W Hook, MD]

Recently healed wounds or sores have a tendency to be a bit more susceptible to getting re-opened when friction (as in sex) is applied.  As long as the wound does not start to become painful, to swell, or to be increasingly red, this should not be aproblem.  EWH

[charliemerino]

Hey Doc. Just a quick update. Went to my urologist and it turned out to be a bacterial infection of my prostate, due to the anal sex. The bacteria made its way all the way to my prostate, causing my symptoms. I'm on the right antibiotics and feeling much better. Just wanted to let you know. Also we started having sex again and the small wound got irritated and opened just a bit (Which it was healing just fine). My last question is - Do you think this is just due to friction/trauma to the wound again? It never had a head/pussed or crusted over and almost healed in a week. Didn't no if herpes did that or not. Just making sure. Thanks again.

[Edward W Hook, MD]

At this point, I would suggest you talk with a urologist.  EWH

[charliemerino]

No improvement of symptoms from the time of onset. And they did not worsen post intercourse, although it did hurt to ejaculate. I did start antibiotics just in case it was STD related - that also did not improve my symptoms. I stopped taking the antibiotics when my test results came back negative, due to the fact they were causing me severe diarrhea. One week has past and symptoms remain the same. Thank you Dr. you have been more than helpful on this subject.

[Edward W Hook, MD]

Given your history, test results an recent events, this iscomfort is unlikely to be an STD.  The lesion you noted is not likely to be HSV and is cerainly not something that you acquired through intercurse the preceding day- newly acquired HSV lesions do not appear until about 4 days, at the earliest, after sex.  

Questions for you- over the interval between when your symptoms began and when you next had sex, did they improve?  Also, did the symptoms recur/worsen after sex on Tuesay?   EWH

[charliemerino]

Hey Dr. Just an update. My test for gonorrhea, chlamydia and non-gonococcal urethritis, were all negative. The problem is I am still having dysuria. A couple of factors that it could be is that I am always on a low carb, high protein diet because of my profession. I have had rabdomyolysis before, just never this painful. Also, when having intercourse with my GF it is long lasting and at times rough. The only other question I had was, my symptoms started last friday with dysuria. Tuesday I had intercourse with my GF, somewhat rough, and the next day (Wednesday) I noticed a small wound. Not raised or puss filled, it was already open, there is only one and it seems to already to be healing but does look circular in nature. Should I be concerned with herpes? I just read that herpes can cause dysuria - I know I should stop reading stuff on the internet! My GF says she has never had anything ever before, which I believe. I am going to my urologist Monday to get more tests done. Thank you for your time.

[Edward W Hook, MD]

Thanks for the additional detail. This sounds like it could be NGU despite the negative prelliminary tests.  

NGU is usually an STD and can be caused when normal bacteria from a partner's genital tract, mouth or rectum get into the urthetra.  the standard approach is that while perhaps not an STD in the same sense as gonorrhea or chlamydial infection, if that is what you are treated for, you partner should be evaluated and treated as well.  

I look forward to hearing what your tests show.  EWH

[charliemerino]

Thank you Dr. Great answers. Yes every time I urinate it causes discomfort. Would antibiotics clear up NGU and is that considered and STD? Sorry for all the questions. Thank you for your time and I will provide an update when I have a definitive answer. Thanks again. Charlie

[Edward W Hook, MD]

Good questions.   I'll be happy to comment.  It sounds like you have pain with urination, something that in medical terminology is called "dysuria".  Do you have discomfort every time you urinate and throughout urination or just some of the time?

Dysuria in men can be caused by any sort of inflammation of the penis with the most frequent causes in men being STDs such as gonorrhea, chlamydia and non-gonococcal urethritis (NGU) or urinary tract infection.  Another possible but less common cause of this sort of discomfort is sometimes passing a kidney stone.  Testing for STDs was a good idea, as was doing a urinalysis (particularly if it was collected just as you began to urinate) which can provide clues to all of the processes I've mentioned.  In addition, sometimes when persons engage in rectal intercourse, the process introduces rectal bacterial into the urethra, causing irritation which can then present as either a urinary tract infection or NGU.  It sounds like you have been evaluated well.  

My advice at this time would be to watch and see what happens.   I suspect that this is not related to your  rectal sex two weeks ago.  This may pass on its own (no pun intended) or it may declare itself and provide clear direction as to what to do next.  If the STD tests are negative, there is no reason that your GF needs testing.  

I hope this helps.  Let me know if I've missed something.  EWH