As of now the burning is mild, it’s noticeable and it’s there but it’s not overly painful. No discharge, other pain, no swelling of testicles, extra urgency to go, etc.  The tip of my penis feels like it’s chafed (it’s not). 

I’ve done a lot of research on your site and in my view it’s either Gon, Chyl or an NGU (or a UTI). Based on what I’ve read I doubt it’s Chyl. 

I was planning a telemedicine visit to get medicine. I know I have something and I don’t want to wait 4 days for test results (due to weekend). I figure doxy would take care of NGU/UTI/Chyl and cefixime would handle any Gon. 

Would you recommend this course of action?  Any other thoughts about my situation would be welcome. 

As I mentioned in an earlier thread, I’m fine getting tested although very afraid of the state reporting  process if positive.  I actually had a health official leave a message on my home voicemail once with details on a very private matter  to contact trace me and ask questions and I don’t want to experience that again. I also don’t want to be asked questions about my partner. She has not been exposed in any way and will not be.  

Thanks. 

Certainly this symptom is consistent with a newly acquired urethral infection, and unprotected oral exposure risks NGU and gonorrhea (but not chlamydia, which I am please you already understand). You don't need to wait 4 days for testing:  if symptoms are present, if the cause is diagnosablelike gonorrhea is present (and even chlamydia, though exceedingly unlikely), testing will detect it. It's only in asymptomatic infection that a 3-4 or maybe 5 day delay is advised. In any case, you can expect all bacterial tests to be negative, which is the situation for >90% of NGU from oral sex.

If the discomfort remains mild, I think it makes sense to wait another couple days, maybe til after the weekend. More evidence (e.g. discharge) might then be more likely, making diagnosis easier. Apart from diagnostic testing per se, you should have a physical exam to evaluate discharge and/or to test a urine sample for WBC, which are the way to diagnose NGU. You can always go sooner (e.g. urgent care) over the weekend if the pain becomes severe.

I would discount concern about state STD reporting. In the US, there have been few if any cases of inappropriate disclosure of test results in the past few decades. Public health agencies take this very seriously, and the penalties for noncompliance are severe. And infected people are never contacted about their infection, partner treatment, etc unless positive for gonorrhea, chlamydia, or syphilis -- and any of these is very unlikely in your case. And even with these, partners are NEVER contacted without the cooperation and participation of the infected person. You would be in control should partner notification be advised. (I speak as someone who directed a large municipal public health STD program for 25 years.)

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

I went for a test today. I’ll keep you updated. Since I’m here, I’ll use my second follow up.  As for your other comment about urgent care, if necessary, what would you recommend for treatment ?  Doxy?  I actually have a 7 day course of 500 mg ciproflaxacin at home (I was misdiagnosed previously and this was prescribed and I stopped taking it). It’s 18 months old. Maybe that’s better off in the garbage at this point? Your thoughts are welcome. 

Thank you 

Wait for your test result before treating with anything -- or if your symptoms significantly worsen (more pain on urination or appearance of abnormal discharge). Were you also evaluated in person, i.e. genital exam for discharge or urine to check for WBCs? If you treat, definitely do not use ciprofloxacin, which works only half the time against gonorrhea and not at all against chlamydia or NGU. Assuming a negative gonorrhea test and if urethritis is professionally confirmed, it should be doxycycline for a week. If gonorrhea, ceftriaxone by injection.

You have one more follow-up coming. I suggest waiting until you have the test results, when you also can tell me about your symptoms at that time (or if they worsen in the meantime).

I did also get a CBC and my WBC came back at 9.9 within the range of 3.4-10.8/x10E3/ul. I don’t really know if that rules out NGU or not. 

The one result that was more out of range was ALT (SGPT) which, via the internet, I learned has to do with my liver and most likely dealing with an infection. Again, I don’t really know how to interpret that, although I’m less than 6 months out from an annual physical and I’ve never been out of range on anything!

What I do know is that I still have mild burning when I urinate and so I will be taking a trip to urgent care on Monday seeking doxy (I presume) to cure this situation. If you think otherwise, I’d be interested in hearing what you have to say. 

Again, I really appreciate the service you and Dr Hook offer. There is so much misinformation about STI’s out there and the fact that you bring a non-judgmental, common sense approach to this forum, in my view, is extremely important. Thank you. 

CBC and blood chemistry are meaningless in this situation. Why were they done?? The CBC is normal and both this and your elevated ALT are irrelevant to this exposure and your urinary discomfort. 

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. I think you can move on with no further worry, assuming normal exam in urgent care. Best wishes and stay safe.