What’s up your bum?
| 09 March 2010
Perhaps unnoticed, undiagnosed and untreated rectal STIs? David Vermeeren reports.
It’s a simple fact that up to 10% of Australian gay men attending sex on premises venues have an undiagnosed sexually transmitted infection (STI) in their rectums; usually gonorrhoea, chlamydia or syphilis. All of these treatable STIs are capable of causing health related problems from pain and discomfort through to infertility and in the case of untreated syphilis, organ failure. Even more crucially, each of these STIs has been identified as increasing the likelihood of HIV being transmitted.
If you’re HIV negative, having an undiagnosed rectal STI increases the chances of you having growths or lesions inside your anal passage through which the HIV Virus can pass more easily. These lesions also attract your own immune cells as your body tries to deal with them; these cells are prime targets for HIV infection. If you’re HIV positive having a second untreated STI will increase the amount of the HIV virus present in your body making it much easier to pass the virus on. HIV can be passed on in a number of ways but the majority of transmissions are through unprotected anal intercourse, so having another STI in the most likely transmission zone substantially increases your odds of getting HIV.
So what’s going on? Testing rates for rectal STIs across Australia are much lower than testing rates for oral and urine based STIs, often enough simply because they usually do not present with significant symptoms. What this means in practice is that gay men when seeking STI testing don’t ask for rectal testing and often enough the general practitioner does not request it either; so these undiagnosed, asymptomatic STIs continue to be passed on.
Testing procedures for STIs have changed over the past couple of years and most clinics now allow you to go into a private room to collect your own urine samples and rectal swabs. The use of a urethral swab (down the eye of your penis) is no longer as commonly used as it was in years past but may still be required in some circumstances. When going in for your STI tests, ask for a full examination, even if you haven’t been having anal sex. Something as simple as someone part inserting a finger into your arse can transmit an STI.
The problem of undiagnosed and untreated STIs is even greater amongst HIV positive gay men. Over half the cases of syphilis diagnosed amongst gay men in South Australia last year occurred in HIV positive men, usually in the rectum. Syphilis represents a particular danger for HIV positive men as the symptoms of syphilis will be more severe, last longer, progress faster and will be much harder to treat. All of which decreases your CD4 cell count and increases your viral load leaving you potentially open to a range of other opportunistic illnesses and to further transmitting HIV.
To find out more about HIV, STIs and their testing and treatment call the Man2Man Infoline on 8334 1617, 1800 671 582 for country callers, email us This e-mail address is being protected from spambots. You need JavaScript enabled to view it or visit the Drama Down Under website on www.thedramadownunder.info/.
David Vermeeren is the Gay Men’s Health Manager – AIDS Council of SA.
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