[Question #11127] Penile discharge after unprotected oral sex

16 months ago

Hi experts,

I have been visiting your site quite frequently and consider myself fairly educated. I limit my sexual activities with everyone to be unprotected oral and 100% protected virginal sex.

~7 days ago, I had 2 such encounters when I was visiting Australia. I have been having some itchy feeling on my penis since than and this morning, I saw white cheese-like pus from my penis without any other symptoms.

I visited the urgent care, and I am prescribed ceffriaxone shot and doxyxycline hyclate capsules. That being said, after discussion, they didn't really send my urine sample out for diagnostics (going back in 3 days) because I am having full STD tests tomorrow at my PCP site and the result from my PCP site will be faster. The urgent care doctor told me what I got should cover what is the most common (Gonorrhea, NGU, and clamydia), but if that is yeast, the antibiotics will make it worse. However, yeast it less likely and has less risks for health outcomes.

I will certainly communicate everything to my PCP when I am visiting him tomorrow, but I am curious whether there is anything I should worry about.

I am indeed worried about HIV but I know it is nearly impossible from my exposures?

Thanks!

16 months ago

Update: we decided to send me urine sample out so we will know what exactly I got.

Edward W. Hook M.D.

16 months ago

Welcome to our Forum. Thank you for your questions and for keeping up to date by looking at other posts on our site. Congratulations on your practice of safe condom protected vaginal sex. There is virtually no risk for HIV from the exposures that you describe. There are no proven cases of HIV acquired from receipt of unprotected oral sex and you are not going to be the first.

The symptoms you describe (white, cheese-like pus from your penis) suggests that you have acquired urethritis (a penile infection) from receipt of oral sex. The most common causes of these infections following oral sex are gonorrhea or non-gonococcal urethritis due to the introduction of a partner's oral bacteria into your penis during oral sex. With either infection, the antibiotics you received will almost certainly improve your symptoms within 24 hours of taking the drugs.

I'm please that you have decided to have a test. If gonorrhea is present the urine test should be positive. if the gonorrhea test is negative, then you almost certainly have non-chlamydia NGU (it is unusual although not unheard of to acquire chlamydia from receipt of oral sex)

I hope this perspective is helpful. Please let us know what your urine test shows. EWH

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16 months ago

Thank you Dr. Hook! I can't describe how comforting I am after hearing from you as such an expert in this field. So thank you so much!! I will surely update. I have some follow-up questions that I forgot asking:

1. Do I need to worry about yeast/fungi considering my symptoms? (white pus today + itchy penis head for a few days, no others) Syphilis?

2. It looks like my test results from urine sample (I am guessing they test for gonorrhea and clamydia?) is not going to influence that fact that I am going to finish my doxyxycline hyclate over 2 weeks. When should I get tested again before having sex with my regular partner?

3. I know gonorrhea and NGU are relatively common from receiving unprotected oral sex. Can you comment how common it is? Just trying to know how 'unlucky' I am.

4. TBH, I am now having paranoid I caught HIV, although I didn't have unprotected virginal sex at all...

Edward W. Hook M.D.

16 months ago

1. Do I need to worry about yeast/fungi considering my symptoms? (white pus today + itchy penis head for a few days, no others) Syphilis?

This sounds nothing like syphilis and syphilis following receipt of oral sex is very, very rare. I presume the doctor examined you . If so, differentiating yeast from a urethritis should be easy. With yeast there is white coating on the outside of the penis and under the foreskin if uncircumcised. On the other hand, urethritis such as gonorrhea ofr NGU originates from inside the urethra/penis

Let's see what your test result show. As long as your urine specimen was tested before or very soon after you received antibiotics, the test results will help to sort this out.

3. I know gonorrhea and NGU are relatively common from receiving unprotected oral sex. Can you comment how common it is? Just trying to know how 'unlucky' I am.

There are no specific figures. On the other hand, that your partner was a commercial sex worker makes it not all that unusual to develop urethritis/'

4. TBH, I am now having paranoid I caught HIV, although I didn't have unprotected virginal sex at all...

Based on what you say, HIV is not a concern

EWH

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16 months ago

Hi Dr. Hook,

The tests for urine samples which were taken before treatment came back negative for gonorrhea, chlamydia, and trichomoniasis. According to what you said, I think I got NGU from some other bacteria, most possible from the oral sex. My questions would be:

1. My symptoms have been improved a lot, as you rightly predicted, as I don't see any pus when I wake up (saw the first day), no dripping to the underwear (saw the first day), no darker color urine when I wake up (saw the first 2 days). I think I no longer can tell from my symptoms whether it is cured or not. How will I know I am clear of infection? Btw, I think I am going to do a virtual visit with my PCP if you think any other tests need to be done. I haven't visited him yet since that happened last Wednesday and I was traveling.

2. The urgent care doctor actually prescribed me 2 weeks of 200mg doxycycline per day. Isn't the recommendation 1 week instead of 2 weeks? As you know, it is well tolerated but sometimes the bad feeling in stomach is not enjoyable...

3. Considering my history (100% protected virginal sex with a few high-end CSWs and unprotected oral sex), should I test for full panel STD sooner to make sure I don't pass anything to my regular partner? As I usually test them bi-annually.

I know it concludes my thread. Thanks so much!!

Edward W. Hook M.D.

16 months ago

I agree with your assessment. As a final response to your follow-up questions:

I'm please to hear that your symptoms are improving. For problems such as yours there is no need for follow-up testing. You are not a threat to future sexual partners and there is no good follow-up test to do,

You are correct. The doctor who treated you gave you more treatment than needed. If you choose to stop taking the doxycycline after 1 week you will be fine and your gastrointestinal symptoms should improve

Periodic testing for persons with multiple partners is always a good idea. That you use condoms correctly and consistently will do much to protect you. As mentioned above, receipt of oral sex is low but not no risk. Testing out of an abundance of caution at six month intervals is a good idea and will be reassuring for you.

Take care. EWH

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