I am 30 year old man (HIV+ for 5 years). The last three years I have had a recurring anal irritation (inflammation, dull achy pain, itching, penile irritation following urination and ejaculation, and dull pain and bloating in my lower abdomen). The irritation lasts a couple weeks (longest a month) and then seems to clear. I have been with the same partner for over two years and have had regular STI screening during this period. My CD4 fluctuates between 400 and 500 (~25%) and viral load has been undetectable since I started treatment. I have been to see my physician, but because it eventually clears, he usually is just treating the symptoms. Do you have any advice on what questions I should be asking to lead my physician to determining a cause so that I can explore more permanent solutions. Thank you in advance for your assistance!

Hard to know anatomically (anal area, urinary bladder, prostate, etc) what is going on here, given the episodic nature. Perhaps a urologist evaluation might be in order.