A Comment On Diagnosis

[viking8x6]

I thought I'd share this experience, as it seems relevant to all of those people who post symptoms on here asking "what bug do you think this is?"

About eight weeks ago, I started to get some irritation in my ass crack, fairly minor but annoying. It didn't seem to be on my anus proper, but in the little fold right above it. I had played with a few guys recently, but only two or so, and they were people I knew and didn't think likely to pass any type of STI to me.

So I washed it well and treated it with OTC antibiotic (triple antibiotic ointment), thinking it a mild skin infection or something.

It did not improve; in fact, it got worse. I managed to get a picture with my phone and it was inflamed, swollen, and somewhat ulcerated.

Now, I knew this could be syphilis, though it didn't look typical, and when I googled "perianal ulcer" it pointed to gono or chlamydia.

So I went to the clinic. This is the urgent care arm of my primary care clinic. They do a lot of women's health, are current on sexual health for gay men (that's one reason I have stayed there), and are generally communicative about detailed diagnosis.

The FNP there looked at it and said most likely a fungal infection, and gave me a topical cream for that.

Five days later, still worsening. I went back.  FNP looked again, said, guess it's a bacterial cellulitis, let's try cephixime.

That seemed to work pretty well for 3 days - pain and swelling went down a lot.  Then it leveled off and stayed the same.

After 5 days of that, went back again. A different FNP this time looked at it, asked about STIs, talked about different things, and said that it might be herpes (which I've never had as far as I know, certainly not there). Apparently the symptoms are different in areas with friction (she mentioned lady parts). So we  did a culture of the wound area and started me on an antiviral med. I wasn't sure to hope it would work, or to hope it wouldn't - because that means I've got herpes - LOL...

5 days later, no change and no word regrading the culture. And then yesterday morning, at last! The clinic called with the culture results.

Apparently, there's a nasty infection there with K. aerogenes, and we've sent in a prescription for cipro.

K. aerogenes ?!? WTF is that?

Glad you asked. It's not an STI, it's not staph or strep, it's a bacterium that is seen in infections of surgical wounds and catheters and such. How I got it in my ass crack, I have absolutely no clue. Hopefully that's all that's wrong in there, but I have high hopes.

🤷‍♂️

So, when you ask, "what does this look/sound like", just be aware that people here can tell you very little about what you actually have.

[PozBearWI]

@viking8x6 I'm wishing you well.  Indeed new stuff emerges all the time.  

[BootmanLA]

One reason this may not be familiar is that it's a new name for something we previously knew as "Enterobacter aerogenes". It's regularly found in the human gut, where it causes few problems, but outside the gut, it can be pretty nasty. It's also susceptible to a small group of antibiotics, but otherwise not really affected by most others, so treatment has to be specific.

Glad they were able to ID this so they could get an appropriate treatment started.

[viking8x6]

2 hours ago, BootmanLA said:

It's also susceptible to a small group of antibiotics

Yes - I was pleased that the lab did a panel of susceptibilities. Apparently K. aerogenes is well-known for frequent resistance to cephalosporins.

[Leather69]

Thanks for the info viking8x6. It just reinforces the requirement for the sexually active to have regular tests for all possible infections. As well as getting the tests to be open with discussions with your medical professionals.

We are lucky in Australia that the tests are covered by Medicare (Fed govt scheme)    .. just the docs feel to pay, less the Medicare rebate.