Herpes Simplex Virus (HSV)

• The MOST common STI worldwide - 90% of the world has at least one strain of the HSV virus! This means there is really nothing you did "wrong", sometimes life just happens.

• Unfortunately, sometimes HSV can mimic our old friend IBD, though.

• Symptoms of an HSV flare up or infection can cause that mimic IBD include:

• Severe, severe anorectal/perianal pain and burning

• Discharge from the perianal area

• Tenesmus (the feeling that you have to poop, but when you go to the bathroom, no poop comes out)

• Fever

• Headache

• Inguinal lymphadenopathy (swollen lymph nodes in your groin area)

• Difficulty passing stool/ pooping

• Ulcer in gluteal cleft ( doctor’s fancy word for buttcrack)

Syphilis

• Syphilis is a systemic sexually transmitted infection (STI) that occurs in stages after infection (primary syphilis, secondary, tertiary)

•      Starts with a Chancre (fancy word for painless genital ulcer)

• Like above, it’s symptoms can mimic other GI disorders including IBD. 

• Most common Syphilis GI symptoms, which mimic IBD include:

• Epigastric pain

• Nausea

• Vomiting

• Gastritis

• Early fullness

• Indigestion

• Diarrhea and/or constipation

• Weight loss

• In primary syphilis, perianal ulcers may occur too.

•   On a colonoscopy it can cause long ulcers, erythema (redness) and edema (swelling) 

• On the genitals it can cause wart like lesions

•  These lesions are painless, flat, velvety and moist. 

• Please please make sure you talk to your doctor if you notice these symptoms and get regular STI testing!

Mpox

Thankfully, the community has worked very hard in vaccination efforts and outbreaks are not as common, but nevertheless, mpox symptoms can mimic IBD!

• NOTE: IF you are on biologics/immunosuppressants, you can’t get any of the currently available Mpox vaccines because they are live vaccines.

•  This includes, but is not limited to:

•    Rash

• Proctitis, may be more common in PLWH (People Living With HIV)

• Firm or rubbery lesions around your anus/rectum area. In some people, these lesions hurt REALLY bad.

• Purulent (smelly) or bloody discharge from the anorectal area 

•     Rectal pain

• Perianal ulcers, and pustules

• Distal rectal ulcers

Chlamydia

• Chlamydia is a sexually transmitted infection that can cause a wide range of symptoms in the belly and gastrointestinal tract, many mimicking IBD, so once again, it’s important to stay aware of what’s going on down there!

• Oftentimes, people can be infected with chlamydia and not have any signs or symptoms either - making it even more important to make sure your partners are getting tested and you are getting tested.

• When/if chlamydia causes GI symptoms, they may include but are not limited to:

• Can cause anal pruritus (itchiness)

• Anal pain

• Anal/rectal bleeding

• Pain or burning while peeing

• Pain during sex

• Lower belly pain

• Abnormal vaginal discharge (may be yellowish and have a strong smell) bleeding between periods (if you are in early stages of transition or having fluctuating T levels, or dealing with other hormonal challenges due to IBD, this symptom may not be weighted as heavily as the others, but still keep it in mind)

• Pus or a watery/milky discharge from the penis

• Swollen or tender testicles

• Pain, discharge and/or bleeding around the anus

• Ulcers in digital rectum (the bottommost part of your rectum, where you would get a rectal exam)

• May cause something called  solitary rectal ulcer syndrome

• Can cause LGV Lymphogranuloma venereum) (ulcers in the genital region)

•   Associated with transient ulcer formation, superficial ulcers, or severe deep ulcers on colonoscopy

•   May cause abdominal cramping

• May also cause Nonspecific proctitis

Gonorrhea

• Gonorrhea is a sexually transmitted infection that can infect the urethra, rectum,reproductive tract, mouth, throat or eyes.

• It is most commonly spread during vaginal, oral or anal sexual activity (vaginal intercourse, oral sex or anal sex)

• In many people, gonorrhea causes no symptoms, but if there are symptoms, they often affect the genital tract, and may occur and travel over to the perianal area and mimic IBD symptoms.

• Can cause a lot of symptoms that mimic IBD, including:

• Pruritus ani (literally, itchy anus)

•   Anorectal pain

•    Constipation

•      Tenesmus (the feeling that you have to poop, but when you go to the bathroom, no poop comes out)

• Painful urination.

• Abdominal or pelvic pain.

• How gonorrhea affects specific parts of the body (kind of similar to IBD, so it’s important we keep an eye out!)

• Rectum: Anal itching, pus-like discharge from the rectum, spots of bright red blood on toilet tissue and having to strain during bowel movements.

• Eyes: eye pain, sensitivity to light, and pus-like discharge from one or both eyes.

• Throat. Throat infection might include a sore throat and swollen lymph nodes in the neck.

• Joints: warm, red, swollen and extremely painful, especially during movement. This condition is known as septic arthritis.

  Perianal Tinea

  • PUT YOUR SOCKS ON BEFORE YOUR UNDERWEAR!!!!

  • Also known as Jock Itch.

  • Asymmetrical erythematous (red) annular (ring shaped) patch. Itchy, hence the name.

  • Scaly, annular (ring shaped) border in the groin

  • Spreads via skin-to-skin contact and via shared objects and surfaces.

  • It can be prevented by hygienic practices such as keeping skin clean and dry, and changing underwear daily, and sexually transmitted Tinea can be prevented by open communication with your partner.

  • STI transmission of Tinea can be prevented via condom use and communication with your partner about their sexual health status

  Perianal Strep (Perianal streptococcal dermatitis)

  • Perianal streptococcal dermatitis (the fancy doctor word for perianal strep) presents as sharply demarcated, beefy erythematous (doctor word for red) ring around the anus with fissuring (sometimes) and exudate (weeping/oozing)

  • Can cause a bright red rash around the anus.

  • It can sometimes spread into the genital area - similar to how it is spread from feet to butt by taking socks off in reverse order.

  • The rash is moist and much redder than diaper rash.

  • Tinea of all flavors spreads very easy, so make sure you prevent the spread to others by washing your hands with soap and water after touching the affected area.

  Perianal Candida (Anal Yeast Infection)

  • Perianal candidal intertrigo (perianal candida infection) presents as soreness and irritation with bright red erythema (red rash) and satellite lesions extending into the natal cleft (doctor word for buttcrack).

  • Symptoms include:

  • Intense and persistent anal itching (pruritus ani)

  • Redness

  • A burning sensation

  • Irritated skin

  • Anal pain and soreness

  • Bleeding or other discharge

  • Anal yeast infection/candida can easily spread to your penis or vagina/genitalia, so you may notice other symptoms in those areas until your infection clears up!