Im sorry to be returning. I am still struggling.

Since we last spoke I have had intense penis pain and burning in head of penis. Urine dipsticks still negative and no discharge or burning on urination. Im only 28 so not sure if prostasis is possible. This has completely resolved now. I did perform a NAAT gonorrhea test which was negative but symptoms had already begun to improve by then.

For my original exposure (protected oral) is this truely no risk even with potential exposure to saliva / bacteria on hands during masturbation?

I really am at my wits end.

Please can you explain to me how the outercourse with my partner cant transmit gonorrhea ? Even if theres precum involved that comes in contact with her anus/vaginal area.

Can I move on with my life or should I come clean and get my partner tested? 

Thank you Dr.

I carefully reviewed our discussion two months ago. I wouldn't change anything and would encourage you to re-read it, if you haven't done so recently. As discussed there, it was absolutely certain you did not have gonorrhea or chlamydia. And there really is no STD likely to cause the symptoms you describe.

If there is redness of the skin of the glans (penis head) or foreskin (if you are uncircumcised), then you might have balanitis -- the medical term for inflammation of the head of the penis. It's not an STD. Some cases are "nonspecific", i.e. no particular cause except perhaps bacterial overgrowth under the foreskin. Some cases are yeast infections -- and since vaginal yeast infections are common in women, genital yeast can be shared between partners, including "outercourse" exposures. If you care to describe your symptoms in more detail, perhaps I can comment further about these possibilities.

You likely are overly focused on the oral sex event:  there is no realistic possibility your symptoms have anything to do with that exposure. For sure you have no STD from it and therefore no STD to transmit to your partner. 

As just implied, I'll be happy to comment further with a bit more detail about your symptoms, what your penis looks like, etc -- and perhaps whether your partner has any symptoms of genital itching or irritation, the main symptoms of vaginal yeast infections (but not of any STD). In the meantime, I hope these comments help.

HHH, MD

The burning lasted for around 2/3 days (on and off worse when sitting) pain in the tip grew in intensity and subsided rapidly, again this was worse when sitting. Symtpoms resolved and then came back intermittently in a cycle until last week. They have now stopped completely. Im circumcised and there was no discharge. There was some observed redness inside the lips of urethra. Im not sure about yeast in my partner, she has made no such complaints. I did have a sore throat for around a month before with mild conjunctivitis in one eye before this started. Not sure if related to yeast ?

I've read much on medhelp about CPPS / anxiety causes of these symptoms and perhaps the tension of worrying about gonorrhea led to this and going back to regular orgasms resolved it ? 

Im still terrified i have given my partner gonorrhea. Is it really true no penetration = no risk for gonorrhea? 

Thanks Dr.

I'm so glad you describe these symptoms so clearly. The combination of pain at the meatus (urethral opening) plus sore throat plus conjunctivitis almost certainly was an infection with adenovirus. It is one of the common cold viruses, but is especially prone to also cause conjunctivitis (pink eye), and sometimes infects the genital tract, often by oral sex but probably hand-genital contact or outercourse can transmit it. Did your wife have a cold around the same time? (No matter if not; many adenoviral infections cause no symptoms.) Among men attending STD clinics, 2-5% of nongonococcal urethritis (NGU) is caused by adenovirus. That your symptoms cleared in a few days also is typical. Here are links to two pertinent scientific publications in case you'd like to delve into the weeds on this:  https://pubmed.ncbi.nlm.nih.gov/16388480/  https://pubmed.ncbi.nlm.nih.gov/37643409/  

Just to confirm i had the sore throat and conjunctivitis then a week or so later the penile symptoms began. Not sure if this still lines up but i guess regardless it still makes more sense than gonorrhea appearing months later without dysuria or discharge. 

Dr to put this to bed for good, I want to just get my risk together see if you agree.

Chances of SW having oral gonorrhea - 0.05 

Chances of passing even without condom - 0.1

Chances of not showing typical syptoms in typical timeframe - 0.2 (at most conservative)

Chances partner had it from 2 outercourse interactions - 0.1 (maybe?)

Chances partner develops PID (0.1)

So all together thats 0.05x0.1x0.2x0.1x0.1 even if hadnt used a condom which i did. So were looking at less than 0.001% chance. I guess if we're wrong about all this im just the unluckiest person on earth. 

Thank you for your reassurance Dr Handsfield. I may just come clean to my wife and get her tested if i cant continue to go on with the guilt but i will certainly be more confident she doesnt have gonorrhea and that it was far more likely we both had adenovirus or some other form of harmless ngu.

I would put the chance of transmission of gonorrhea to your wife by outercourse at a lot lower value than 10% (0.1), probably well under 1%. I would also put the odds of having urethral gonorrhea without symptoms at 5% (0.05), not 20%. However, even with your numbers I agree the bottom line chance of your partner having a gonorrhea problem is zero for all practical purpose. (I haven't done the math myself, especially decimal point counting, but you're on the right path.)

We don't get into relationship advice, so I have no advice about whether or not to discuss all this with your wife. However, it certainly is true that some couples find discussion of sexual indiscretions with the spouse often can be very therapeutic -- especially when the relationship itself is inherently strong, as it seems to be in your case.