Timeline:

- December 10 2022: received unprotected oral sex from a colleague

- No symptoms for 10 days so I deemed safe to resume sex with my GF

- December 20 2022: unprotected vaginal sex with my GF

- January 2 2023: unprotected vaginal sex with my GF

- January 10 2023: I develop epididymitis (swollen right testicle, painful to touch), but no symptoms at all of urethritis (no burning, no discharge, nothing)

- I took Cipro and later switched to Doxy (due to concerns about the black box warning of Cipro) and epi went away quickly.

- Following Dr. Hook's advice, I tested 2 weeks later and was negative for both gono and chlamydia.

This happened between December and January. After that, I only had sexual intercourse with my GF for the rest of the year, up until today - I would estimate 25-30 episodes of unprotected sex.

On November 21 I started feeling pain in my left testicle and again a doctor diagnosed me with epididymitis!

Again, no discharge nor burning, the difference this time is that it's on the other side (left testicle) and that there was no swelling or redness, just pain when touching the epididymis. Now on Bactrim and pain is almost gone after 5 days.

Questions:

1) Is it possible that I caught chlamydia in December last year, passed it to my GF, got cured, and then got reinfected 11 months later? She has had 0 symptoms in these 11 months.

2) Is it possible that I caught chlamydia, passed it to my GF, got cured, reacquired it right away but only got epididymitis 11 months later?

3) Does the fact that there was no swelling - just tenderness - mean something (maybe I have chronic epi now)?

4) What are my next steps?

It is frustrating that once again your doctor has started antibiotic treatment apparently without testing you again for STDs, and apparently without studies to confirm epididymitis (like testicular ultrasound). I'm glad your symptoms are improving with sulfa-trimethoprim (Bactrim), but like ciprofloxacin it is not the best treatment for either gonorrhea or chlamydia.

2) That scenario is virtually impossible, especially if you have not had other symptoms (discharge from your penis) during those eleven months.

3) As implied above, this suggests you might not have epididymitis at this time.a

4) Follow up with your doctor. If s/he is not a urologist, consider referral to a urologist at this time for more complete evaluation.

Best wishes--   HHH, MD

Thank you for the helpful answers.

I have a few follow up questions:

1) Regarding my first question and scenario, my concern is that I had sex with my GF twice after the oral sex and before taking cipro and doxy (and later testing negative). Is it conceivable that she could have been infected in one of those two occasions (December 20th of last year) but only passed the infection (either gono or chlamydia) back to me 11 months later?

2) You said that "Epididymitis symptoms sometimes recur, without necessarily meaning a new infection has occurred"

That was my first thought given the milder epi symptoms and the fact that it's been almost 1 year since my oral sex "incident".

However, is it possible for symptoms to recur (without new infection) but affecting the other testicle? My initial epi in January involved the right testicle and this time around it's the left one.

3) I agree that my doctor's approach was not great (public clinic where docs are in a rush to see many patients). Would it make sense to get tested now? Or will the Bactrim affect the results?

Thanks again for your time

2) I didn't realize it was the opposite testicle, so this cannot be new pain from the previous epididymitis. 

3) Yes, it makes sense to see a urologist now -- the sooner the better. And yes, Bactrim could affect the results, especially since your symptoms have improved. Still, seems to me it's a good idea to see a urologist. On the other hand, it probably would be safe to hold off, finish the Bactrim, but plan on seeing a urologist if and when any pain develops in either testicle -- with no antibiotic treatment prior to being seen. In any case, all things considered I am confident this isn't an STD issue.

No further questions, your answers were very helpful.

In closing, having glanced back at your previous thread, I agree that epididymitis was likely to start, but I believe it was a coincidence with the sexual exposure 3 weeks earlier -- that no STD was responsible. That's unprovable at this point, but one strong aspect -- both for that episode and the current one -- is that I have never see or heard of sexually acquired epdididmitis that did not include obvious urethritis, i.e. urethral discharge and usually painful urination. I am even less concerned about the present testicular pain, which might not be epididymitis at all but is even less likely to be due to an STD. 

This doesn't change my judgment about next steps as suggested above. But it reinforces the need for carefully urological evaluation and proper testing if or when you have yet another episode of testicular pain in the future.

I'll leave this thread open for one more cycle in case these comments generate additional concerns or questions.