[Question #11890] NSU aftermath
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11 months ago
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Hello all just wanted to start off by saying this is an amazing service and after viewing some answers i wanted to ask my own question. I am a male.
On 8/3 i received unprotected oral by a female sex worker i had seen before. Vaginal sex was protected.
On 8/5 i masturbated quite a bit (4 times within the span of an hour or so) and the. in 8/6 after urinating i felt like i didn’t finish, a pressure on the tip of my penis. On 8/7 i visited an urgent care and urine was tested for G/C both came back negative but was given Doxy for 7 days before results. Urinalysis was normal besides some blood in it. After doxy symptoms didn’t really resolve and on 8/19 visited doctor and tested by urine for G/C, Mgen, ureaplasma, Myco Hominis, and all other STD. All results have came back negative which is a relief but symptoms still kinda persist although they tend to come and go. Mostly just a pressure at the tip of my penis and a right testicle dull ache that comes and goes.
My question is are my tests results conclusive and should i chalk it up to genital anxiety? I have been really anxious and when i think about it the symptoms linger, once i get distracted they tend to go away. I know sometimes normal oral bacteria can irritate the urethra. If so, how long until everything clears up?
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H. Hunter Handsfield, MD
11 months ago
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Welcome to our forum and thanks for your kind words about it. I'll happy to answer this.
Oral sex should be viewed as safe sex: all STDs are low risk, and some are zero (such as HIV, for example). Second, your symptoms were not typical for NGU; most likely you just experienced some physical discomfort due to the somewhat excessive masturbation. NGU symptoms do not include a sensation of incomplete urination, or any kind of pain or "pressure" at the tip of the penis. (As it happens, my colleague Dr. Hook was the senior investigator on probably the best research study that showed such symptoms don't occur with sexually acquired urethritis.)
Did the urgent care provider swab your urethra or otherwise test for increased white blood cells? (Apparently none in your urine or you would have mentioned it.) Was abnormal discharge observed? If not, it confirms no urethritis -- and had you been in my clinic, we would not have treated you with doxycycline (or anything else). Lack of improvement with doxycycline is additional evidence your symptoms were not from NGU. Finally, the lab tests were unnecessary, since except for gonorrhea, not one of the other infections tested is carried in the oral cavity or, if present, transmitted to the genitals by oral sex. (Chlamydia is a rare exception, but could not have persisted after doxycycline treatment.) Finally, infection symptoms do not "come and go".
All things considered, indeed I would "chalk it up to genital anxiety". Your symptoms certainly are typical for psychological factors magnifying minor symptoms or even normal body sensations that otherwise would be ignored or not even noticed. And whenever someone suspects their own symptoms have a psychological origin, usually they are right!) I am quite confident that once you become convinced -- emotionally as well as intellectually -- that you have no infection, your symptoms will fade away.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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11 months ago
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Thank you for the response!
My urinalysis at my primary doctor checked for elevated WBC’s and RBC’s and all came back normal. No trace of blood in that second urine test as well. Just a trace of bacteria which was considered normal now and in previous urinalysis i’ve had throughout the years.
I have never had any unusual discharge at all, no pain or burn with urination, no pain during ejaculation.
Just a follow up question, since I completed the Doxy, and tested for the myco/ureaplasmas. I can be confident in those results and not fear a “false negative?” That seems to be my main concern in all of this. I want to continue unprotected sex with my girlfriend of many years and I do not want to expose her to anything.
The only symptoms I have left are that slight pressure at the tip (almost like as if a hair was stuck in there or ONE last drop of urine) and was that symptom goes away my right testicle has some ache. It always almost seems like they tag team which leads me to understand you when you say that its a matter of accepting my negative results and emotionally/intellectually moving forward.
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H. Hunter Handsfield, MD
11 months ago
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As I said, Ureaplasma and the genital mycoplasmas are not carried orally, even in people who frequently perform oral sex on their partners -- so genital infection cannot be acquired from oral sex. There was no point in testing for them; but in any case, the negative results are to be believed. And these bacteria are not known to cause the symptoms you have described. And testicular pain definitely is a common symptoms in people with genitally focused anxiety. You might want to google chronic pelvic pain syndrome (CPPS -- but spell it out). Genitally focused anxiety can be considered the short term version of the same problem, i.e. minus "chronic". The Wikipedia article is good, and there's also excellent info from the Stanford University Dept of Urology. I'm pretty confident you'll see lots of parallels with your symptoms. (CPPS is harmless, by the way; it's an issue of comfort only, not a significant health risk.)---
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11 months ago
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Got it! To conclude, I can move on to having sex with my significant other without worry correct?
I appreciate all of the info and the reassurance. I’ll be looking into CPPS and i know the more calm I am the symptoms will go away as you said.
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H. Hunter Handsfield, MD
11 months ago
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Yes, you certainly can safely have sex with your regular partner. You needn't ever have stopped. (And for what it's worth, some urologists advise increased sexual frequency as beneficial for CPPS and similar problems.)
That concludes this thread. I hope the discussion has been helpful. Best wishes and stay safe.
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