[Question #10468] Emotionally drained

Avatar photo
22 months ago
7/28 received unprotected oral. 7/29 unprotected oral and attempted vaginal intercourse.  Same woman both days. Condom broke while  penetrating. Stopped immediately. 7/30  Noticed unusual sensation at tip of penis. Frequent urination. 8/3 Burning & stinging at tip of penis is unmistakable. Never any noticeable discharge. Some itch along urethra. Also feeling of heat and some pain. 8/18 Tested (Gon., Chly., Trich., Hiv, Syp. Herpes, Hep.) All negative. 8/18 Begin Doxy 100 mg 2/day for 9.5 days. No relief from Doxy. 8/28 1000 mg Azithromycin 8/29-8/31 500 mg/day azith. 9/12 symptoms somewhat resolved but still some mild burning at tip of penis. Have used anti fungal creams as well which helped with itch but still burning at very tip of penis inside urethra. 9/25 Retested for HIV, herpes, syphilis, Hep. All negative. 10/4 Stinging at the tip seemingly just inside urethra. Seems like it is becoming more pronounced. Occasional itch (several times per day) along urethra.  (1) Does this sound like mgen? (2) What other possibilities since other tests are neg.? (3) If mouth bacteria is causing this, how do I get rid of it? How dangerous are fluoroquinolones? (4)What is the likelihood that I could pass this to my long time partner? Symptoms definitely not just in my mind. BTW I am uncircumcised.
Avatar photo
Edward W. Hook M.D.
22 months ago
Welcome to our Forum.  Thanks for your questions.  I'll be glad to comment.

First, your exposure.  It sounds as though there was no vaginal penetration.  If so, there is no risk for HIV and little risk for other STIs.  Receipt of oral sex is about the lowest form of penetrative sexual exposure with the primary risk for gonorrhea which yo have now tested negative for.

Second, your symptoms.  These symptoms are not symptoms of any STI.  Urinary frequency is a symptom of non-STI urinary tract infections including prostatitis but is not an STI symptoms.   Symptoms such as itching (internal or external) or stringing are likewise not STI symptoms.  In this setting however we frequently encounter clients who are looking hard for symptoms and in this situation commonly notice normal sensations which would otherwise not be noticed.  Repeated self-examination can also cause symptoms of its own right through self examiination.

Third.  Your tests.  Your tests were taken at a time when they would be reliable and should be believed. These tests are quite good.

Forth.  Therapy.  The therapy you have taken would have cured gonorrhea, chlamydial, syphilis and NGU.  No response is yet another sign that this is not an STI.

My strong sense is that this is not an STI.  You may have the CPPE (chronic pelvic pain syndrome) which is, once again, not an STI and is rarely improved with antibiotics of any sort. Finally, in answer  to you specific questions:

(1) Does this sound like mgen? 
No, M. gen causes discomfort on urination and visible penile discharge (which is easily detected- please do not go vigourosuly lookin for a discharge.)

(2) What other possibilities since other tests are neg.? 
See above.  I am confident thatthis is not an STI.

(3) If mouth bacteria is causing this, how do I get rid of it?
If you had NGU from mouth bacteria, both the doxycycline and the azithromycin you took would have cured it.  

 How dangerous are fluoroquinolones?
You do not need antibiotics.

 (4)What is the likelihood that I could pass this to my long time partner?
Virtually zero.

I hope that these comments are helpful.  EWH 

---
Avatar photo
22 months ago
Dr. Hook, thank you for your rapid response. I know from reading on this site and from my own personal experience that a situation like this can make someone hypersensitive. However, I am absolutely 100% certain that my symptoms started after this encounter. I desperately want to believe that there is nothing to worry about, but it is imperative that I get this right because my life will be irrevocably changed for the absolute worse if I do not. (1) Isn't it true that mgen can present with milder symptoms than what you describe? (2) Could my persistent symptoms be a sign of antibiotic resistant mgen? I have read discussions on this site about adenovirus causing urethritis. (3) Is there a test for Adenovirus and what would be the cure? The woman stated that sometimes she gets thrush from using an inhaler for asthma. She sometimes takes diflucan to treat it. (4)Should I be tested for candida and is there a urine test for candida? (5) What is the likelihood that oral sex triggered prostatitis? BTW, urinalysis has shown blood in urine, but I think that this has been brought to my attention at a previous exam long before this situation. I just started drinking Green Tea and a bit of Cranberry juice in hopes that something will bring relief. Not knowing what direction to go is the worst. 
Avatar photo
Edward W. Hook M.D.
22 months ago
Your replies and their tone mirror, the anxiety-driven responses of other clients with similar complaints. Your symptoms are simply not those of an STI. In response to your specific questions.:

1.  I’m not sure what you mean by milder symptoms. The CDC does not recommend testing persons with symptoms such as yours for M. genitalium.

2.  You can’t let this go. Why don’t you just get tested for mycoplasma genitalium and prove to yourself that you don’t have it

3. Adenovirus urethritis does not cause the symptoms you described, and this is self limited illness for which symptoms have entirely resolved within two weeks of infection. Your persistent symptoms do not reflect adenovirus infection.

4.  Candida infections, men and men present as a rash, which is often scaly and quite obvious. Your symptoms do not suggest candida.

5.  If you have prostatitis, and this would be an unusual presentation for prostatitis, it would not have been triggered by receipt of oral sex, but merely coincidental. A common misunderstanding, even among healthcare professionals, is that prostatitis may be due to STI‘s. This is almost never the case.

Your follow up questions also suggest that you have been searching the Internet and efforts to address your questions. I advise you not to do that. The Internet is not edited and there is no way to tell whether the so-called information there is true or not. All too much of what I said there is misleading, and sometimes is either out of date, taken out of context, or simply wrong. EWH
---