"I was 10 pounds lighter and my gastrointestinal microbiome would have to be completely rebuilt from scratch."

Think you know everything about gay men’s sexual health? Think you’re in good hands with your gay doctor or LGBT health clinic? Think New York City’s Department of Health does a good job educating the gay community about how to stay healthy?

You don’t know shit. Fortunately, for you, this is a story about shit.

I have a lot of sex. Topping, bottoming, oral, rimming. I love it all. Living in New York City as a gay man, sex has never been easier to find. I can find it on apps, at the gym, at bars and clubs, on the subway. Anywhere. And amazingly, in my 18 years of sexual activity, I’ve never contracted gonorrhea, chlamydia, or syphilis. Now that I’m on PreP, I no longer fear contracting HIV. As long as I get my quarterly STD testings, there’s nothing to worry about, right? Wrong.

I’m here to wake you the fuck up.

Four years ago, I started experiencing awful diarrhea. My bowel movements would come out as a brown soupy mess. Everyone gets diarrhea, no big deal. But after a few weeks of terrible, horrible, no good, very bad diarrhea, I decided it was time to see a doctor. The physician’s assistant at my doctor’s office didn’t have any answers for me, but recommended a stool test so a lab could analyze my shit and see what was going on inside.

For those of you who have never done a stool test, it’s not like the SATs. You take the test kit home, poop into a bowl on your bathroom floor (or maybe your office’s bathroom floor depending on what time business calls—try explaining that to your co-workers), then with a spoon or tongue depressor, shovel your own excrement into various vials and containers. You then drop the sample off at a lab and wait four-five days for results.

My results came back positive for giardia.

Dr. George Wilder

What the fuck is giardia? I had never heard of it before. Giardia, I soon learned, is a parasite that infects the gastrointestinal system. It’s common in developing countries that don’t have clean water systems. You can contract it by ingesting or coming into contact with contaminated foods, soil, or water tainted by the feces of an infected carrier. You can also contract it from anal-oral contact. Rimming. Like I said, I love rimming. The chances are high I contracted it from a sexual partner.

My PA prescribed me an antibiotic called metronidazole to wipe the giardia from my system. I’m generally reluctant to take antibiotics: I have friends who run to the doctor and demand them for the slightest cold, and I’m worried that the overuse and improper use of antibiotics creates superbugs that will render the medicines useless. But when a parasite like giardia is feeding on you from the inside, you really have no other choice.

I took the week-long regimen of metronidazole. Then I had to wait a month and submit a follow-up stool test to make sure the giardia was out of my system. Poop, shovel, drop it off. The results came back negative, showing that the treatment was successful and I was giardia-free.

Unfortunately, however, my gastrointestinal system was free not only from giardia, but also from all the “good” bacteria that makes up my microbiome, too. The gastrointestinal system uses good bacteria to digest food, regulate nutrients, protect against pathogens, and regulate body weight. Without this good bacteria, my body was unable to digest food properly and my poop was still a soupy mess.

My doctor instructed me to take probiotics (which I found in the refrigerated section of the health department at Whole Foods). It took several months of probiotic use for my bowel movements to return to normal, but at least my health was in the clear and I felt free to return to having sex without the risk of spreading the parasite.

Fast forward to the spring of 2017. PreP had recently ushered in the second sexual revolution and everyone was now fucking each other like it was 1979. My wonderful boyfriend and I enjoyed a healthy sex life inside and outside our open relationship. Then he started experiencing stomach problems: diarrhea, bloating, stomach aches, nausea. All too familiar with those symptoms, I recommended he go to the doctor and ask for a stool test. It was his turn to experience the whole routine: poop in a bowl on the floor, shovel shit into vials, and drop it off at the lab.

His results came back positive for giardia. He and I had been doing plenty of rimming, so I knew there was a good chance I had been exposed to the parasite. I wasn’t experiencing any symptoms, but decided to put myself through the stool test protocol to be sure. Poop, shovel, drop it off. Miraculously, my results came back negative. Somehow, I had managed to escape the microscopic fangs of giardia. My boyfriend took the metronidazole regimen and eliminated the parasite from his system.

We were in the clear, right?

Well, just a few months later, summer of 2017, my boyfriend started experiencing another bout of diarrhea and stomach cramps. It couldn’t possibly be giardia again, could it? Now on high alert after his first parasite infection, he rushed to the doctor and demanded a stool test. Poop, shovel, drop it off. This time the results came back positive for entamoeba histolytica. What the fuck is entamoeba histolytica?! I knew giardia. Giardia and I were on a first name basis. But entamoeba, what now?

CDCP

Entamoeba histolytica, as it turns out, is another parasite common in developing countries spread through contaminated drinking water, poor hygiene when handling food, and…rimming. The PA treating him wasn’t familiar with entamoeba histolytica or how to treat it, so she had to research (Google?) how to handle the infection. The medical literature (Google search results?) led us back to metronidazole, the same antibiotic used to treat giardia.

The doctor recommended that I get tested for entamoeba histolytica, too. Inconveniently, I was away from home working in a small, remote town, and wouldn’t return to New York City for several weeks. I had to find a medical lab in this quaint village that could process a stool test. Compounding the challenge, I didn’t have access to a car or bike nor was Uber or Lyft available.

The nearest stool-test equipped lab was a mile down the road at the local hospital emergency room. So I walked to that hospital, explained my situation to the laboratory receptionist, and she kindly arranged for me to receive a stool test kit. I walked the mile back to my AirBnB apartment. Poop, shovel, walk the mile back to the hospital, drop it off.

Later that afternoon, just when I thought the humiliation couldn’t get any worse, the lab called me to say they had inadvertently forgotten to write my date of birth on the poop vials before they submitted them for processing. The vials were rejected and couldn’t legally be processed. I would have to submit new poop vials. Just flames. Flames on the side of my face.

I took a deep breath and walked the mile back to the hospital and picked up a new stool test kit. The lab receptionist apologized profusely for the error and gave me a $10 gift certificate to the hospital gift shop. I didn’t have any use for stuffed teddy bears or “Get Well Soon” balloons, but appreciated the gesture nonetheless. She offered me access to a private bathroom where I could generate another stool sample, but I politely declined. I’m no monkey. I don’t poop on command, thank you.

I walked the mile back to my AirBnB, where, the next morning, I had another successful bowel movement. Poop, shovel, walk the mile back to the hospital, and drop it off. My duty was done.

frank600

A few days later, a PA in my doctor’s office back in New York City called to say my test results had come back positive for entamoeba histolytica. I, too, would have to go on antibiotics. She prescribed two antibiotics: metronidazole, to kill the adult parasites, and paromomycin, to be taken after completing the metronidazole to destroy the parasite cysts the metronidazole couldn’t kill.

“Hold up!” I said. “My boyfriend and I both have entamoeba histolytica infections. Why are you prescribing me two antibiotics when your office only prescribed him one?”

Her reply was basically, “Ummm, oops?” She and the PA who had written my boyfriend’s prescription seemed to be guessing at how to treat it and hadn’t consulted with each other before writing the prescriptions. They were unfamiliar with this particular parasite and the standard protocol for treatment.

My boyfriend, already several days into his metronidazole prescription, was then given another prescription for paromomycin. He was not happy with me for basically pulling the medical equivalent of “Teacher, you forgot to assign homework!”

I began and finished the metronidazole regimen. There were no major side effects. It was then time for the paromomycin. My gastrointestinal system had a severe reaction to it, turning every ounce of food I ate immediately into liquid. It was like a fucking magic trick. I spent the next week running to the bathroom several times a day to shit my brains out. By the end of the treatment, I was 10 pounds lighter and my gastrointestinal microbiome would have to be completely rebuilt from scratch. That meant lots and lots of probiotics.

Douglas Sacha

I began taking probiotic pills and discovered a powerful probiotic kimchi made by Sinto Gourmet at an Asian grocery store in Koreatown. It’s actually delicious and surprisingly refreshing to eat first thing in the morning. Still, it took several weeks for my bowel movements to return to anything identifiable as normal.

I go to one of the busiest LGBT health clinics in the city for my quarterly PreP follow up and STD screening. This past fall, I went in for my follow up and the doctor asked the routine, “How has your health been?”

I gave him all the shitty details. I asked him, “Have you noticed an uptick in parasite infections in the gay community in New York City?”

“No,” he said, “but, honestly, that’s not really our primary focus.”

“If a patient comes in with a parasite infection,” I asked, “do you encourage their sexual partners to get tested?”

“No, we only test someone for a parasite if they display symptoms,” he said.

“But gay men don’t even know they’re at risk! We didn’t learn about parasites in sex ed class. No doctor has ever warned me about it. I’ve never seen the departments of health or the CDC put out any educational materials on the subject.” I ranted, breathlessly. “And when guys contract parasites, they’re too embarrassed to talk about it, I can’t be the first person in this city to get giardia or entamoeba histolytica.”

I looked at him soberly. “Listen, you are one of the largest providers of healthcare to the LGBT community in New York City, maybe the largest, and I think you could be doing more to educate men who have sex with men about sexually transmitted gastrointestinal parasites and the risks of rimming!”

“Yeah…” he acquiesced. “You’re probably right.”

I walked out of there proud of myself for speaking up, but pessimistic anything would come of it. At least I was healthy.

Fast forward to November 2017 and it started all over again. I started shitting my brains out.

No, no, no, this can’t be another parasite, can it? Maybe it’s just food poisoning. Maybe I just drank too much this week. Please don’t be another parasite. I can’t go through the testing and treatment again.

I ran to my doctor and asked for a stool test. Poop, shovel, drop it off. A week later, the PA called and gave me the bad news: It was giardia.

Chris Bjornberg

So here I am, infected with giardia for the second time in my life after having eradicated entamoeba histolytica from my body just months earlier. My boyfriend has also been exposed to both.

But we can’t be the only ones.

I don’t know how many of you out there have sexually contracted a gastrointestinal parasite, but I do know our health care providers and departments of health are failing when it comes to keeping us informed about this issue.

The friends I’ve told about giardia and entamoeba histolytica all have the same response, “What is that?!” They are blissfully ignorant of either parasite, while engaging in the same sexual acts that put them at risk of contracting them.

I don’t have any easy answers here, but I’m hoping to begin a dialogue and spread awareness. If you’ve taken anything from my shitty experience, ask your doctor about how your sexual practices may put you at risk of contracting a gastrointestinal parasite.

Tell your friends about this gross story you read on the internet. And maybe, just maybe, think twice before you chow down on another dude’s ass.