Bacterial and Viral Infections Transmissible via Anal Contact

Anal contact (sexual or otherwise) can transmit numerous enteric and sexually transmitted pathogens. Risk depends on practices, partner status, and immune competence.

Bacterial Infections

Viral Infections

Pathogen	Disease	Key Features
Shigella spp.	Shigellosis	Bloody diarrhea, fever, tenesmus; low infectious dose (10–100 organisms); MSM outbreaks; rising antibiotic resistance
Salmonella spp. (non-typhoidal)	Salmonellosis	Watery/bloody diarrhea, fever, cramps; foodborne but sexual transmission documented
Campylobacter spp.	Campylobacteriosis	Diarrhea (often bloody), fever, cramps; Guillain-Barré trigger; common in MSM
E. coli (EHEC O157:H7, EAEC, ETEC)	Colitis, travelers’ diarrhea	Bloody diarrhea, HUS risk (O157); watery (ETEC); sexual transmission possible
Clostridioides difficile	C. diff colitis	Diarrhea, pseudomembranes; spore-forming; antibiotic-associated; sexual transmission rare but possible
Neisseria gonorrhoeae	Rectal gonorrhea	Often asymptomatic; discharge, pain, bleeding; co-infection with chlamydia common; antimicrobial resistance rising
Chlamydia trachomatis (LGV serovars L1–L3)	Lymphogranuloma venereum	Ulcerative proctitis, fistulas, strictures; systemic symptoms; endemic in MSM
Treponema pallidum	Syphilis	Chancre (primary), rash (secondary), neurosyphilis; rectal mucosa highly susceptible

Parasitic/Protozoal

• Giardia lamblia (giardiasis)
• Entamoeba histolytica (amebiasis)
• Cryptosporidium (cryptosporidiosis)

Prevention

• Condoms (latex/polyurethane) for anal sex – reduce but don’t eliminate all risks.
• Dental dams for anilingus.
• PrEP for HIV (daily TDF/FTC or event-driven; injectable cabotegravir).
• Vaccines: Hep A, Hep B, HPV (through age 45), Mpox (high-risk).
• Regular STI screening (NAAT for GC/CT, syphilis serology, HIV) – q3–6 months if multiple partners.
• Hygiene: gentle cleaning; avoid douching/enemas (disrupt microbiome, increase susceptibility).

Clinical Pearl

Symptomatic proctitis (pain, discharge, bleeding, tenesmus) in MSM → test for GC, CT (including LGV), HSV, syphilis, HIV. Empiric treatment often covers GC+CT pending results.

Open, nonjudgmental sexual health counseling saves lives.

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Pathogen	Disease	Key Features
Hepatitis A	Acute hepatitis	Fecal-oral; sexual transmission (MSM outbreaks); vaccine-preventable
Hepatitis B	Acute/chronic hepatitis	Blood/sexual; high infectivity; vaccine-preventable
Hepatitis C	Chronic hepatitis	Blood primarily; sexual transmission inefficient but increased with HIV, rough sex
Human Papillomavirus (HPV)	Anal warts, cancer	High-risk types (16, 18) → anal dysplasia/cancer; vaccine prevents
Herpes Simplex (HSV-1/2)	Genital/herpetic proctitis	Painful ulcers; recurrent; asymptomatic shedding
HIV	AIDS	Receptive anal intercourse: highest sexual transmission risk (1.4% per act); PrEP/PEP effective
Mpox (Monkeypox)	Mpox	Close contact; 2022 MSM outbreak; vaccine available