Delayed Diagnosis of Rectal Gonorrhea Due to Healthcare Provider Reluctance

Case at a Glance

A 19-year-old male presented with rectal symptoms following unprotected oral contact and protected anal intercourse. Despite clear symptom onset correlation with sexual activity, multiple healthcare providers failed to perform appropriate STI testing, resulting in a 3-month delay in diagnosis and treatment of rectal gonorrhea.

Patient's Story

The patient presented with acute onset of rectal burning, itching, and pain beginning 1-2 days after sexual contact involving protected anal intercourse and unprotected oral-rectal contact. He was forthright about his sexual history and symptom timeline, expressing concern about possible sexually transmitted infection. The patient had a family history of Crohn's disease.

Initial Assessment

The primary care physician focused primarily on the family history of inflammatory bowel disease rather than the acute presentation and recent sexual exposure. Despite the patient's direct request for STI testing and the clear temporal relationship between symptoms and sexual activity, the provider declined to perform testing or provide empirical treatment. The patient was referred to gastroenterology with a 1-month wait time.

The Diagnostic Journey

The gastroenterology consultation occurred one month later, recommending colonoscopy and referral to colorectal surgery. Colonoscopy results were normal. When the patient again raised STI concerns, he was referred to infectious disease with an additional 2-month wait. Frustrated by the prolonged process, the patient sought care at a sexual health clinic where rectal swab testing was immediately performed.

Final Diagnosis

Rectal gonorrhea, confirmed by nucleic acid amplification testing of rectal swab specimen at the sexual health clinic.

Treatment Plan

The patient received appropriate antibiotic therapy according to CDC guidelines for gonococcal infection. Partner notification and testing were recommended. The patient was counseled on risk reduction strategies including consistent barrier protection and consideration of pre-exposure prophylaxis options.

Outcome and Follow-up

The patient responded well to treatment with resolution of symptoms. This case highlights the importance of comprehensive sexual health assessment in primary care and the need for healthcare providers to maintain non-judgmental approaches to sexual health concerns. The 3-month delay in diagnosis could have resulted in complications and ongoing transmission to partners.