Aseptic meningitis from herpes simplex virus proctitis

Sexually transmitted proctitis, a prevalent concern among men who have sex with men (MSM) is frequently caused by a range of pathogens, including herpes simplex virus (HSV), <i>Neisseria gonorrhoeae</i> and <i>Chlamydia trachomatis</i> While HSV-associated proctitis typically presents with visible lesions, cases without external manifestations remain evasive. We report the case of an MSM in his early 30s presenting with dyschezia and perineal discomfort after unprotected anoreceptive intercourse. Despite initial inconspicuous findings, rectal swabs revealed HSV-2 infection. Subsequent escalation to purulent discharge prompted further investigation, revealing mucosal thickening on imaging consistent with proctitis. Remarkably, the patient later exhibited symptoms suggestive of aseptic meningitis, with cerebrospinal fluid (CSF) analysis confirming HSV-2 DNA. This atypical progression underscores the covert threat posed by HSV-2 proctitis, potentially culminating in neurological complications. Our case highlights the imperative for heightened vigilance and comprehensive testing in MSM engaging in receptive anal intercourse, advocating for early detection and intervention to prevent grave sequelae.