Unexplained anal pain and ulceration.


Q: I am a 25yo gay male with a 6 week history of anal itching and pain and associated white mucoid discharge with defecation. These symptoms began after having unprotected intercourse with a partner whose STD status was unknown. Self digital rectal exam reveals raised papules around the inner rim of the anal sphincter that are very tender to the touch. There is no associated blood, bloody stool, or lesions either on the exterior skin or in the groin area. Lab work from 2 weeks ago revealed no elevated WBC count, negative chlamydia and gonorrhea tests, and a negative herpes 1, 2, and simplex. Past medical history is positive for molluscum contagiosum, chlamydia, HIV, and HPV infection (history of anal condylomata). HIV is not currently being treated due to a CD4 count over 800 and viral load less than 1000. Other lab work is unremarkable and I have no other symptoms.


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