[Question #1071] Deeply concerned

51 months ago
Good morning Doctors
I am very worried about my health and that of my female partner. 
About 12 weeks ago I foolishly received 5 second unprotected oral sex from female CSW. I have had many symptoms since including nausea, sleeplessness, weight loss, burning/tingling/heat in groin and penis. I was given antibiotics to kill off bacterial STDs about a week post exposure. I have tested negative for all STDs at the 3 day, 5 week, 8 week mark (HIV, HSV 1/2, Gon, Chlam, Syph, Trich, Hep A/B/C). Just took a OraQuick mouth swab at 11.5 weeks and was negative for HIV. 
My female partner and I have been engaging in unprotected sex (oral, vaginal, anal) since I received my negative STD results at 8 weeks post exposure. 
About 4 days ago during vaginal sex, female partner felt sharp pain in lower abdominal/pelvic area. She described pain as excruciating and said pain lasted about 8-12 hours afterwards. Since, pain has varied from 5/10 to 0/10 in abdominal/pelvic area. Sitting down seems to relieve pain and movement and straining seems to make it worse. She has had a history of ovarian cysts but has never had persisting pain like this. We have not had sex since. She has not seen a medical professional yet because we think it is a ruptured cyst from vigorous sex. 

1. What do you think could be going on here with female partner with abdominal/pelvic pain?

2. Ruptured Cyst v PID? 

3. Could I have caused this even though I have repeatedly tested negative for STDs ? 

4. I have continuous burning and tingling and increased penis sensitivity myself after 12 weeks post exposure with no other symptoms. Does this mean anything? 

Thanks for your help doctor. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
51 months ago
Welcome to the forum. Thanks for your question. The bottom line is that there is virtually no chance you infected your partner with any STD acquired during the oral sex event described, or that her symptoms are due to PID from that event. 

Receiving oral sex is safe sex -- not entirely risk free, but far lower chance of STD than unprotected vaginal or anal sex. Second, gonorrhea is the only STD likely at all from that event and which can cause PID -- but your gonorrhea tests plus the antibiotic treatment make it impossible that you had gonorrhea when you and your partner resumed sex with one another 8 weeks later. Your negative chlamydia test (and probably the antibiotics) also rule out chlamydia, but that's very rarely if ever acquired by oral ses anyway. (You were WAY overtested given the nature of the event! And didn't need the antibiotics either.)

To your specific questions:

1,2) There is no way to distinguish PID versus a ruptured cyst based on symptoms alone. If she has no fever, that favors cyst versus PID or other infection. OTOH, some serious infections occur without fever. Also, the same symptoms could be a ruptured appendix, diverticulitis, or any number of other serious problems. This requires professional exam and perhaps abdominal imaging (ultrasound, CT scan, or MRI) or laparoscopy. Given her history of previous cysts, that seems most likely -- but she definitely should see a doctor ASAP to evaluate it. Even if it's "only" a cyst, that in itself could be dangerous and urgently needs to be professionally managed.

3) Whatever the cause of your partner's problem, it is completely unrelated to your oral sex event. No way, no worries.

4) These symptoms are not suggestive of any infection. They are typical, however, for genitally focused anxiety -- i.e. your worries and guilt about a regretted sexual event making you more sensitive to trivial symptoms or even normal body sensations that you otherwise would ignore or not even notice. If they continue, you might consider seeing a doctor for confirmation -- but from all you say here, I'm confident they are not due to any infection, and certainly no STD from your oral sex event several weeks ago.

I hope this has helped. Please return with a follow-up comment to let me know the outcome after your partner has seen a doctor. She should do that immediately.

Best wishes--  HHH, MD

---
51 months ago

Dr Handsfield,

First off I wanted to give a wholehearted thank you for helping put my mind at ease. I have taken what you said to heart and have some follow up questions. These last 12 weeks have been some of the most stressful of my life. With that being said, I wanted to fill you in on what’s happened.

I realized that I left off some key info from my last post. Approx 5 weeks and 2 days after the possible exposure, I noticed approx 1/3cm diameter bump (resembled blister but no liquid) that was pinkish/flesh colored on upper penis shaft. Didn’t hurt to touch, and went away after 10 days with no ulcerated/scabbing.

I talked to my partner about what we discussed and she is convinced that is a cyst and will go away after her next period. She is very stubborn and dislikes going to see doctor. She says pain is 1-2/10 pain in lower abdomen and still comes and goes.  My partner is about 8 days late on period. She just took 2 separate pregnancy tests so I don’t think it’s that. I told her to go see the doctor ASAP because something isn’t right.

 

 

1.     1. Yesterday morning, I noticed some white discharge from penis is ….Resembled Pre-cum but seemed more white and slightly thicker and I’ve never noticed anything like this before.

What could this white discharge be?

 

2.     2. 2 days ago, I noticed a very small bump (looks like pimple with whitehead) approx. 1/10cm of underside of penis shaft close to where scrotum meets. It’s in a hairy area but no hair follicle observed.  I popped it and pus came out. It has refilled and looks about the same. Doesn’t hurt to touch.                                                                                     Could this be indicative of herpes?

 

3.     3. The main thing I’m worried about now is herpes because I know you can get it from oral sex. With the symptoms I’ve had (single blister looking bump at 5 weeks with no ulceration/scabbing, intermittent (50-75% of day) burning/tingling on groin, penis and inner thighs, single small pimple on bottom of penis shaft  at 12 weeks. I tested negative at 8 weeks for HSV1/2.                                                                    Chances this could be HSV 1 and/or 2?

 

 

4.     4. I plan on getting tested one more time for herpes 1&2 tomorrow (IGG specific test) at 12 weeks and 1.5 days since event in question.                                                                                                                    If negative, will this rule out that I contracted herpes with 100% certainty?

 

 

5.     5. Also another thing I’ve omitted, I have purplish rash that resemble “stretch marks” on inner thighs/groin fold that could be burning/tingling. Groin also stinks more than usual.                                    

Thoughts on possible causes?

 

6.     6. My female partner is still in 1-2/10 pain (comes and goes) in lower abdomen and is now 8 days late on period. We had vaginal sex yesterday and she said it didn’t hurt.             She has also felt nauseous last 2 mornings and vomited today.                 

What do you make of this?

Have you ever seen herpes present this way in a female?


7. Could all of this be attributed to a lesser known STD that would not show up on test?                                    

 

Thanks for all that you do. Your expertise has been invaluable.  I have been very scared and you have helped my nerves tremendously. I look forward to reading your reply. I really do appreciate it. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
51 months ago
First, your partner is correct:  you had some sort of cyst or pimple; no STD causes this sort of thing. I am confident it is unrelated to your sexual exposure or your partner's symptoms.

1) If your discharge was spontaneous, see a doctor to check it out. If it occurred during a bowel movement, almost certainly you self-expressed some prostate gland or seminal vesical fluids. This happens normally from time to time in men, some more frequently than others.

2-4) Herpes doesn't behave like this. And initial herpes would never start this long after exposure. I wouldn't have recommended herpes testing  in a case like this, but feel free to have another test. You can expect another negative result.

5) No STD is a possible cause of such skin markings. They are normal in many people, especially in those who are over weight or have had recent significant weight gain or loss.

6) I have no way to diagnose your partner's symptoms. But I remain confident they are not PID or any other STD from your oral sex even a few weeks ago.

7) There is no known "lesser known STD" that doesn't show up on routine testing. 

Thanks for the thanks. I'm glad my previous comments helped and hope that these also are reassuring for you.

---
51 months ago

Thank you Dr. Handsfield

Just wanted to update you on situation…. Full STD panel done (HIV, HSV 1 and 2, Gon, Chlam, Hep A/B/C, Syph all negative at 12 weeks and ½ day and all came back negative.

Went to urologist and he said that it most likely a pelvic floor issue v prostatitis v psychosomatic and unlikely to be herpes. My female partner had period about 10 days ago and has since not experienced any more pelvic pain.

AS of today which is 13 weeks and 1 day post exposure….I continue to experience redness around urethral opening, sensitivity in penis (almost feels raw at times), more redness than usual in penis shaft/head after sex/masturbation, groin/penis burning/tingling.

My questions are as follows.

 

1.     Urologist thinks I have fungal infection and inflammation of urethra…. He told me to put Lotrimin antifungal on groin fold (purple rash) and to take NSAID to hopefully reduce inflammation. Thoughts on this?

 

2.     If I was your patient, what advice would you give me about current situation?

 

3.     Can I definitively rule out all STDs at this point?

 

4.     If symptoms don’t go away in months to come, what else can I do?

 

5.     My partner wants to conceive a child, do you have any reservations about us attempting this at the present moment?

 

 

I apologize if I sound repetitive but your reassurance is helping my state of mind tremendously. I have been to many doctors here and none of them can seem to figure out what’s going on.

Just wanted to say thank you from bottom of my heart for helping poor souls like me. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
51 months ago
1) Most people who complain of abnormally red urethral openings look entirely normal when I examine them. But I cannot second guess your urologist. However, fungal infections of the urethra are rare and I doubt this explains your symptoms or the redness. In any case, I remain confident that your symptoms have nothing to do with the sexual exposure described above or your wife's symptoms.

2,4) Based on all you have said, I would advise you to forget all this and ignore your symptoms. I am confident you have nothing that will ever harm you or your partner, and suspect your symptoms will fade once you come to understand they aren't important. All human beings have unexplained symptoms from time to time, not indicating disease:  headaches, abdominal discomfort, the sprained ankle that sometimes aches long after it has healed. The genitals are no different.

3) Yes.

5) I have absolutely no reservations about conception and its safety.

Really, just move on. Your mind is mixing up a sexual decision you regret with medical consequences of that decision. They aren't the same. Deal with the former however you need to (perhaps professional counseling if you just can't let it go). But forget the latter part. There are no medical consequences here, just your anxiety magnifying normal body sensations or trivial symptoms that you otherwise would ignore or might not even notice.

Thanks again for the thanks. That completes the two follow-up comments and replies included with each question, and so ends this thread. Please note that repetative questions are not permitted. Please don't post any new threads about this situation unless or until a new, definite diagnosis is made.

---