A Gay Man with Anal Discharge
A 20-year-old gay man, Eric, presents to a Sexual Health clinic with a 5-day history of constipation and discomfort in the anal region. He has noticed that his stools have been coated with “slime” tinged with blood. There are no other symptoms, his general health is good, and there is no relevant past history. His most recent sexual contact had been 1 week previously with an unknown British male with whom he had unprotected receptive anal intercourse. He has had no other sexual contacts within the preceding 6 months. Eric first became sexually active at the age of 17 years and he has had about 20 lifetime sexual partners. With the exception of his most recent sexual contact, insertive and receptive anal intercourse has been protected. He had a sexual health screen about 1 year previously when no infection was found. At that time he had been vaccinated against hepatitis A and B, and subsequent serological testing showed that he had a good antibody response to the former vaccine. He has no known drug allergies.