[Question #11932] concerned about symptoms

11 months ago

50 yo m. On 5/26 had unprotected fellatio & protected vaginal <5 min each w/ 40+ yo escort. During oral received cut on still-attached foreskin (I'm "mostly" circumcised). Understand these are low risk but does that mean 1:100? 1:1,000? Within days I felt "pinching" on the attached foreskin. Mid-June had a feeling of something in my urethra, like passing a stone. By early July was replaced by urethral irritation (not pain). By end-July urethral irritation gone & hasn't returned. The "pinching" persists & others arose (sensitivity along frenulum & urethral opening, sometimes soreness of the glans). Most feel like they're on the outside. Some days are better, others worse; activity/manipulation makes them worse, cool sooths. Other sporadic symptoms are dull ache in one testicle & sensation in pubic hair area.

Are these symptoms of an STI?

If not, what could be causing them?

Could I have HSV2? IGG test negative at just <7 wks and no lesions

H. Hunter Handsfield, MD

11 months ago

Welcome to the forum. Thank you for your confidence in our services.

You describe a very low risk exposure for any and all STIs. First, escorts (expensive female sex workers by appointment) tend to have low STI rates: typically they care about their health, use condoms for vaginal or anal sex, get tested frequently, and usually have low risk clients -- men like you. Second, condoms work and unprotected oral sex is inherently low risk. Because a properly used condom that doesn't break is close to 100% protective, your circumcision status makes no difference in your risk.

As for your symptoms, they are not typical for any STI. I suspect your anxieties over the event are magnifying minor symptoms or even normal body sensations that otherwise would not be bothersome and maybe not even noticed. Herpes is definitely not a possibility in this situation, and testing for HSV2 was unnecessary. (You can't get HSV2 from oral sex, and here too the condom protected you.)

I don't advise any further STI testing at all. If you symptoms continue and/or you remain concerned, I would suggest seeing your doctor or perhaps a urologist. If something physically in fact is the problem, I am confident it is not an STI and is unrelated to the sexual exposure you have described.

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

HHH, MD

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11 months ago

Dr. Handsfield,

Thank you for the reply. At the beginning of paragraph 3, did you mean that my symptoms are "not" typical for any STI?

As further information - when i was experiencing the urethral issues, I was tested at an urgent care clinic and GP for gon., chlam., trich., mycoplasma, and ureaplasma. All were negative. Given my anxiety/guilt, at 6+ weeks post encounter, I took a multi-panel test for gon., chlam., syphilis, hepatitis, HIV, HSV1, HSV2. All were negative except HSV1, which i already knew. Lastly, I met with a urologist shortly after the cessation of the urethral issues and he prescribed 30 days of doxycycline.

With all the negative tests and course of doxy, can I be 100% sure that I don't have a bacterial STI?

Can I be reasonably sure that I don't have hep., HIV, HSV2 (you've commented on HSV2 already)?

Can I resume sex with my wife without fear for her health?

H. Hunter Handsfield, MD

11 months ago

Yes indeed -- sorry for the typo -- glad you understood anyway! (For the benefit of other readers, I'll go back and edit that statement, adding "not".)

As you might imagine given my ititial reply, you were way over tested. Even if one or more of those infections was found, I would have advised you had them prior to this exposure. And for what it's worth, some of the tests you had were entirely irrelevant: no genuine STI expert uses the "comprehensive" test panels offered by many labs. Some are irrelevant (Ureaplasma and the genital mycoplasmas -- with one exception) are entirely normal, cause no symptoms, and don't need treatment. The tests for HSV are inherently unreliable for several reasons -- but it's good your results were negative. In any case, you were not at risk for any of the infections for which you were tested.

And doxycycline for 30 days???!!! A whole month???!!! No STD requires such treatment and it shouldn't have been done. Did you do that on your own or with a doctor's advice? Shame on either or both of you; all you've done is make it less likely you will be effectively treated if you ever need doxycycline for a future infection. If you or your doctor were seeking prevention on account of exposure, a single 200 mg dose was all that was needed to prevent syphilis and chlamydia; doxycycline is entirely unreliable for all other STIs.

You can be 100% certain you have none of the infections mentioned, including viral hepatitis, HIV and HSV2; you never had a good reason to stop having sex with your wife and certainly can do so now.

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11 months ago

I appreciate the very strong assertions that I have nothing to worry about. I've read many other posts and logically came to that conclusion, but my guilt-driven anxiety had kept me from believing it. Combined with the onset of the symptoms (or perhaps the recognition of symptoms) immediately after the event, I've had a very difficult time moving forward.

Your response to question #11924 is also quiet helpful. I particularly value your calculation of the odds of infection.

Thanks again!

H. Hunter Handsfield, MD

11 months ago

I'm glad you found the quantitative/statistical approach helpful in that other thread. Similar calculations apply to your situation. Thanks for the thanks.---